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Generative chromoendoscopy for gastric neoplasms: a multicenter prospective study.

Sho Suzuki^1,2, Yusuke Monno³, Hiroyuki Yamamoto⁴

¹International University of Health and Welfare Ichikawa Hospital, Department of Gastroenterology, Chiba, Japan, Ichikawa.

|May 8, 2026

Summary

Generative chromoendoscopy, an AI-driven tool, enhanced gastric neoplasm visibility compared to white-light imaging. This novel technique proved feasible and comparable to real chromoendoscopy in a clinical setting.

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Area of Science:

Gastroenterology
Medical Imaging
Artificial Intelligence

Background:

Generative indigo carmine chromoendoscopy (generative chromoendoscopy) is a novel AI-based image-enhanced endoscopic technique.
Its clinical feasibility and efficacy in improving gastric neoplasm visibility remain unvalidated.

Purpose of the Study:

To evaluate the clinical feasibility of generative chromoendoscopy.
To compare the visibility of gastric neoplasms using generative chromoendoscopy versus conventional white-light imaging (WLI) and real chromoendoscopy.

Main Methods:

Prospective, multicenter study involving 60 patients with early gastric cancer or adenoma.
Deep neural network transformed WLI images into generative chromoendoscopy images.
Endoscopists assessed lesion visibility on a 7-point Likert scale during live endoscopy.

Main Results:

Generative chromoendoscopy showed improved visibility scores (0.67 ± 0.93) compared to WLI.
Visibility was comparable to real chromoendoscopy (0.51 ± 1.00), with a mean difference of 0.16.
Differentiated-type histology, H. pylori infection, and expert status were associated with higher visibility.

Conclusions:

Generative chromoendoscopy is feasible for live endoscopic procedures.
It enhances the visibility of gastric neoplasms compared to WLI.
The technique achieves visibility comparable to real chromoendoscopy.