BACKGROUND: Studies regarding the discrimination of non-neoplastic lesion, adenoma, and cancer of the stomach using magnifying endoscopy with flexible spectral imaging color enhancement system (FIME) in each different channel of that system have not yet been reported. AIMS: To ascertain the usefulness of FIME discriminating among the three kinds of gastric lesions. METHODS: When finding a lesion to be a possible neoplasm using conventional endoscopy, the examiner discriminated among the three kinds of gastric lesions by observing the pit pattern on the lesion using magnifying endoscopy with white light (WLME) and then recorded the image. The procedure was repeated three more times with FIME with channel 0, 2, and 4. The four recorded images per lesion were then given to four raters for discriminating among the three kinds of gastric lesions. RESULTS: The proportion of agreement and the degree of agreement between endoscopic and pathological diagnosis (AEP) by WLME were 0.85 and 0.76, respectively, and those by FIME were 0.91 and 0.86, respectively. All AEPs from discriminations with FIME was higher than that with WLME. AEPs from the discriminations with FIME with channel 4 were higher than those with FIME with channel 0 or 2. The degree of interobserver agreement among the results of the four raters was 0.42 for WLME and 0.50-0.59 for FIME with each of the three different channels. CONCLUSIONS: FICE is useful in discriminating among non-neoplastic lesions, adenoma, and cancer of the stomach, and channel 4 of the FICE is better than channel 0 and 2 for the discriminations.