Visibility Evaluation of Fundic Gland Polyp Associated With Proton Pump Inhibitor in Texture and Color Enhancement Imaging

Ryota Uchida; Hiroya Ueyama; Tsutomu Takeda; Shunsuke Nakamura; Yasuko Uemura; Tomoyo Iwano; Momoko Yamamoto; Hisanori Utsunomiya; Daiki Abe; Shotaro Oki; Nobuyuki Suzuki; Atsushi Ikeda; Yoichi Akazawa; Kumiko Ueda; Mariko Hojo; Shuko Nojiri; Takashi Yao; Akihito Nagahara

doi:10.1002/deo2.70147

Visibility Evaluation of Fundic Gland Polyp Associated With Proton Pump Inhibitor in Texture and Color Enhancement Imaging

DEN Open. 2025 May 22;6(1):e70147. doi: 10.1002/deo2.70147. eCollection 2026 Apr.

Authors

Ryota Uchida¹, Hiroya Ueyama¹, Tsutomu Takeda¹, Shunsuke Nakamura¹, Yasuko Uemura¹, Tomoyo Iwano¹, Momoko Yamamoto¹, Hisanori Utsunomiya¹, Daiki Abe¹, Shotaro Oki¹, Nobuyuki Suzuki¹, Atsushi Ikeda¹, Yoichi Akazawa¹, Kumiko Ueda¹, Mariko Hojo¹, Shuko Nojiri², Takashi Yao³, Akihito Nagahara^{1

4}

Affiliations

¹ Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan.
² Medical Technology Innovation Center Juntendo University School of Medicine Tokyo Japan.
³ Department of Human Pathology Juntendo University Graduate School of Medicine Tokyo Japan.
⁴ Department of Pathophysiological Research and Therapeutics for Gastrointestinal Disease Juntendo University School of Medicine Tokyo Japan.

Abstract

Objectives: A 'gray color sign' (GCS) is a new endoscopic feature of fundic gland polyp associated with proton pump inhibitor (PPI-FGP). Here, we compare the ability of texture and color enhancement imaging (TXI) to white light imaging (WLI) with regard to the detection of GCS.

Methods: In this prospective study, 19 consecutive patients with PPI-FGP were enrolled at our hospital from April 2021 to October 2022. Endoscopic images of PPI-FGP using WLI, TXI mode1 (TXI-1), TXI mode2 (TXI-2), and narrow-band imaging (NBI) were collected and compared by 10 endoscopists. Visibility of GCS by each mode (Image enhancement endoscopy) was scored as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. The inter-rater reliability (intra-class correlation coefficient, ICC) was also evaluated. The images were objectively evaluated based on L* a* b* color values and the color difference (ΔE*) in the CIE LAB color space system.

Results: Improved visibility of GCS compared with WLI was achieved for: TXI-1: 82.6%, TXI-2: 86.9%, and NBI: 0% for all endoscopists. Total visibility scores were: TXI-1, 44.9; TXI-2, 42.9; NBI, 17.4 for all endoscopists. Visibility scores were significantly higher using TXI-1 and TXI-2 compared with NBI (p < 0.01). The inter-rater reliability for TXI-1 and TXI-2 was "excellent" for all endoscopists. The use of ΔE* revealed statistically significant differences between WLI and TXI-1 (p < 0.01).

Conclusions: TXI is an improvement over WLI for the visualization of GCS, and can be used by both trainee and expert endoscopists with equal efficiency and accuracy.

Keywords: fundic gland polyp; fundic gland polyp associated with proton pump inhibitor; gray color sign; proton pump inhibitor; texture and color enhancement imaging.