Image-enhanced endoscopy in upper gastrointestinal disease: focusing on texture and color enhancement imaging and red dichromatic imaging

Abstract

Endoscopic examination plays a crucial role in the diagnosis of upper gastrointestinal (UGI) tract diseases. Despite advancements in endoscopic imaging, the detection of subtle early cancers and premalignant lesions using white-light imaging alone remains challenging. This review discusses two novel image-enhanced endoscopy (IEE) techniques-texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI)-and their potential applications in UGI diseases. TXI enhances texture, brightness, and color tone, which improves the visibility of mucosal irregularities and facilitates earlier detection of neoplastic lesions. Studies have suggested that TXI enhances the color differences between lesions and the surrounding mucosa and improves the visibility of the lesion. TXI aids in the diagnosis of various UGI diseases, including early gastric cancer, esophageal cancer, premalignant conditions such as atrophic gastritis and Barrett’s esophagus, and duodenal tumors. RDI utilizes specific wavelengths to enhance the visualization of deep blood vessels or bleeding points, aiding in the rapid and accurate identification of bleeding sources during endoscopic procedures. Although promising, TXI and RDI require further large-scale studies across diverse populations to establish their clinical utility, diagnostic performance, and cost-effectiveness before integration into the guidelines. Standardized training is also required for effective utilization. Overall, these IEE techniques has the potential to improve the diagnosis and management of UGI.