Texture and color enhancement imaging versus high definition white-light endoscopy for detection of colorectal neoplasia: a randomized trial

Abstract

BACKGROUND Texture-and-Color-Enhancing-Imaging(TXI, Olympus, Japan) was recently proposed as a substitute to standard high-definition white-light(WLI) to increase lesion detection during colonoscopy. We performed an international, multicenter randomized trial to assess the efficacy of TXI in detection of colorectal neoplasia. METHODS We enrolled consecutive patients ≥40 years old undergoing screening, surveillance or diagnostic colonoscopies at 5 centers (Italy, Germany, Japan) from September 2021 through May 2022. Patients were randomly assigned (1:1) to TXI or WLI (controls). Primary outcome was Adenoma Detection Rate(ADR). Secondary outcomes were adenomas per colonoscopy(APC) and withdrawal time. Adjusted Relative Risks (RR) for age, sex and colonoscopy indication were calculated. RESULTS We enrolled 747 patients, men: 50.2%, mean age 62.3 ±9.5 years. ADR was significantly higher in the TXI group (221/375, 58.9%) versus WLI group (159/372, 42.7%; adjustedRR:1.38[95%CI:1.20-1.59]). This was significant both for ≤5mm (RR:1.42[1.16-1.73]) and 6-9mm (RR:1.36[1.01-1.83]) adenomas. A higher proportion of both polypoid (151/375, 40.3% vs. 104/372, 28%; RR:1.43[1.17-1.75]) and non-polypoid adenomas (136/375, 36.3% vs. 102/372, 27.4%; RR:1.30[1.05-1.61]) and both proximal (143/375 [38.1%] vs 111/372 [29.8%], RR, 1.28[1.05–1.57]) and distal (144/375 [38.4%] vs 98/372 [25.6%], RR, 1.46 [1.18–1.80]) lesions were found in the TXI group. APC was higher in the TXI group (1.36 ±1.79 vs 0.89 ±1.35; incident rate ratio, 1.53[1.25-1.88]). CONCLUSIONS In a randomised trial, TXI increased ADR and APC among unselected patients undergoing colonoscopy for various indications. TXI increased detection of polyps <10mm in size, both in the proximal and in the distal colon, and may help to increase colonoscopy quality indicators.

Efficacy of texture and color enhancement imaging for the visibility and diagnostic accuracy of non‐polypoid colorectal lesions

“…Recently, a multicenter randomized controlled trial indicated that, compared to WLI, TXI improves the detection of colorectal neoplastic lesions. 26 This study found that TXI increased the detection of polyps <10 mm in size, both in the proximal and in the distal colon and both in non‐polypoid and polypoid lesions. However, the previous generation of colonoscopes (190 and 290 series) was also included.…”

Impact of linked color imaging on the proximal adenoma miss rate: a multicenter tandem randomized controlled trial (the COCORICO trial)

“…Color contrast enhancement technologies, such as LCI, have been developed to improve the visualization of these lesions, which are challenging to detect with WLI. In the only previous tandem study evaluating pSSLMR with LCI, no significant difference was found, but the Olympus), with some promising results [33].…”

“…In summary, even though LCI appears to be the most promising modality among the currently available enhanced image contrast systems, our data challenge its benefit and should prompt consideration regarding the future optimization of this technology. The development of a new generation of virtual chromoendoscopy is underway, such as texture and color enhancement imaging, with some promising results [32].…”

Next generation of virtual chromoendoscopy improves adenoma detection during colonoscopy

“…The beauty of the current study by Antonelli et al [3] is the simplicity of the technique. The new-generation virtual chromoendoscopy is already integrated into the new video processor and the technique is available by simply pressing a button.…”