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Endoscopy 2023; 55(12): 1072-1080
DOI: 10.1055/a-2129-7254
Original article

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

Giulio Antonelli 
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
2   Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, Italy
,
Gerolamo Bevivino
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Silvia Pecere 
3   UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma
,
Alanna Ebigbo
4   III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
,
Fabrizio Cereatti 
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Naoki Akizue
5   Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Michela Di Fonzo
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Manuela Coppola
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Federico Barbaro
3   UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma
,
Benjamin M. Walter
6   Department of Gastroenterology, Clinic for Internal Medicine, University Hospital Ulm, Germany
,
Paranjay Sharma
7   Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
,
Anna Caruso
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Kenichiro Okimoto 
5   Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Claudia Antenucci
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Tomoaki Matsumura
5   Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Giulia Zerboni
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Cristina Grossi
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Michael Meinikheim
4   III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
,
Luigi Giovanni Papparella 
3   UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma
,
Loredana Correale
7   Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
,
Guido Costamagna 
3   UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma
,
Alessandro Repici
7   Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
8   Humanitas Clinical and Research Center –IRCCS-, Endoscopy Unit, Rozzano, Italy
,
Cristiano Spada
3   UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma
,
Helmut Messmann
4   III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
,
Cesare Hassan
7   Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
8   Humanitas Clinical and Research Center –IRCCS-, Endoscopy Unit, Rozzano, Italy
,
Federico Iacopini
1   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04892966 Type of study: Prospective, Randomized, Multicentric
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Next generation of virtual chromoendoscopy improves adenoma detection during colonoscopyEndoscopy 2023; 55(12): 1081-1082
DOI: 10.1055/a-2189-4890

Abstract

Background Texture and color enhancement imaging (TXI) was recently proposed as a substitute for standard high definition white-light imaging (WLI) to increase lesion detection during colonoscopy. This international, multicenter randomized trial assessed the efficacy of TXI in detection of colorectal neoplasia.

Methods Consecutive patients aged ≥ 40 years undergoing screening, surveillance, or diagnostic colonoscopies at five centers (Italy, Germany, Japan) between September 2021 and May 2022 were enrolled. Patients were randomly assigned (1:1) to TXI or WLI. Primary outcome was adenoma detection rate (ADR). Secondary outcomes were adenomas per colonoscopy (APC) and withdrawal time. Relative risks (RRs) adjusted for age, sex, and colonoscopy indication were calculated.

Results We enrolled 747 patients (mean age 62.3 [SD 9.5] years, 50.2 % male). ADR was significantly higher with TXI (221/375, 58.9 %) vs. WLI (159/372, 42.7 %; adjusted RR 1.38 [95 %CI 1.20–1.59]). This was significant for ≤ 5 mm (RR 1.42 [1.16–1.73]) and 6–9 mm (RR 1.36 [1.01–1.83]) adenomas. A higher proportion of polypoid (151/375 [40.3 %] vs. 104/372 [28.0 %]; RR 1.43 [1.17–1.75]) and nonpolypoid (136/375 [36.3 %] vs. 102/372 [27.4 %]; RR 1.30 [1.05–1.61]) adenomas, and 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 [26.3 %]; RR 1.46 [1.18–1.80]) lesions were found with TXI. APC was higher with TXI (1.36 [SD 1.79] vs. 0.89 [SD 1.35]; incident rate ratio 1.53 [1.25–1.88]).

Conclusions TXI increased ADR and APC among patients undergoing colonoscopy for various indications. TXI increased detection of polyps < 10 mm, both in the proximal and distal colon, and may help to improve colonoscopy quality indicators.

Tables 1 s–6 s



Publication History

Received: 26 March 2023

Accepted after revision: 14 July 2023

Accepted Manuscript online:
14 July 2023

Article published online:
07 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
    CrossrefPubMedSearch in Google Scholar
  • 2 Brenner H, Chang-Claude J, Seiler CM. et al. Protection from colorectal cancer after colonoscopy: a population-based, case–control study. Ann Intern Med 2011; 154: 22-30
    CrossrefPubMedSearch in Google Scholar
  • 3 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
    CrossrefPubMedSearch in Google Scholar
  • 4 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
    CrossrefPubMedSearch in Google Scholar
  • 5 Zhao S, Wang S, Pan P. et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 2019; 156: 1661-1674.e11
    CrossrefPubMedSearch in Google Scholar
  • 6 le Clercq CMC, Bouwens MWE, Rondagh EJA. et al. Postcolonoscopy colorectal cancers are preventable: a population-based study. Gut 2014; 63: 957-963
    CrossrefPubMedSearch in Google Scholar
  • 7 Anderson R, Burr NE, Valori R. Causes of post-colonoscopy colorectal cancers based on world endoscopy organization system of analysis. Gastroenterology 2020; 158: 1287-1299.e2
    CrossrefPubMedSearch in Google Scholar
  • 8 Facciorusso A, Triantafyllou K, Murad MH. et al. Compared abilities of endoscopic techniques to increase colon adenoma detection rates: a network meta-analysis. Clin Gastroenterol Hepatol 2019; 17: 2439-2454.e25
    CrossrefPubMedSearch in Google Scholar
  • 9 Thayalasekaran S, Frazzoni L, Antonelli G. et al. Endoscopic technological innovations for neoplasia detection in organized colorectal cancer screening programs: a systematic review and meta-analysis. Gastrointest Endosc 2020; 92: 840-847.e9
    CrossrefPubMedSearch in Google Scholar
  • 10 Hassan C, Spadaccini M, Iannone A. et al. Performance of artificial intelligence in colonoscopy for adenoma and polyp detection: a systematic review and meta-analysis. Gastrointest Endosc 2021; 93: 77-85.e6
    CrossrefPubMedSearch in Google Scholar
  • 11 Spadaccini M, Iannone A, Maselli R. et al. Computer-aided detection versus advanced imaging for detection of colorectal neoplasia: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol 2021; 6: 793-802
    CrossrefPubMedSearch in Google Scholar
  • 12 Bisschops R, East JE, Hassan C. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – update 2019. Endoscopy 2019; 51: 1155-1179
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Paggi S, Radaelli F, Senore C. et al. Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program. Gastrointest Endosc 2020; 92: 723-730
    CrossrefPubMedSearch in Google Scholar
  • 14 Atkinson NSS, Ket S, Bassett P. et al. Narrow-band imaging for detection of neoplasia at colonoscopy: a meta-analysis of data from individual patients in randomized controlled trials. Gastroenterology 2019; 157: 462-471
    CrossrefPubMedSearch in Google Scholar
  • 15 Sato T. TXI: Texture and color enhancement imaging for endoscopic image enhancement. J Healthc Eng 2021; 2021: 5518948
    CrossrefPubMedSearch in Google Scholar
  • 16 Moher D, Hopewell S, Schulz KF. et al. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 2010; 63: e1-37
    CrossrefPubMedSearch in Google Scholar
  • 17 Lai EJ, Calderwood AH, Doros G. et al. The Boston Bowel Preparation Scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
    CrossrefPubMedSearch in Google Scholar
  • 18 The Paris endoscopic classification of superficial neoplastic lesions. esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-43
    PubMedSearch in Google Scholar
  • 19 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
    CrossrefPubMedSearch in Google Scholar
  • 20 Hassan C, Antonelli G, Dumonceau J-M. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – update 2020. Endoscopy 2020; 52: 687-700
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Chow S-C, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research: 3rd edn. Boca Raton: Chapman & Hall/CRC; 2017
    CrossrefSearch in Google Scholar
  • 22 Gupta S, Lieberman D, Anderson JC. et al. Spotlight: US Multi-Society Task Force on Colorectal Cancer recommendations for follow-up after colonoscopy and polypectomy. Gastroenterology 2020; 158: 1154
    CrossrefPubMedSearch in Google Scholar
  • 23 Wisse PHA, Erler NS, de Boer SY. et al. Adenoma detection rate and risk for interval postcolonoscopy colorectal cancer in fecal immunochemical test–based screening: a population-based cohort study. Ann Intern Med 2022; 175: 1366-1373
    CrossrefPubMedSearch in Google Scholar
  • 24 Meester RGS, van Herk MMAGC, Lansdorp-Vogelaar I. et al. Prevalence and clinical features of sessile serrated polyps: a systematic review. Gastroenterology 2020; 159: 105-118.e25
    CrossrefPubMedSearch in Google Scholar