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

Giulio Antonelli; Gerolamo Bevivino; Silvia Pecere; Alanna Ebigbo; Fabrizio Cereatti; Naoki Akizue; Michela Di Fonzo; Manuela Coppola; Federico Barbaro; Benjamin M. Walter; Paranjay Sharma; Anna Caruso; Kenichiro Okimoto; Claudia Antenucci; Tomoaki Matsumura; Giulia Zerboni; Cristina Grossi; Michael Meinikheim; Luigi Giovanni Papparella; Loredana Correale; Guido Costamagna; Alessandro Repici; Cristiano Spada; Helmut Messmann; Cesare Hassan; Federico Iacopini

doi:10.1055/a-2129-7254

Endoscopy, Table of Contents

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

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

²Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, Italy

,

Gerolamo Bevivino

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

,

Silvia Pecere

³UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma

,

Alanna Ebigbo

⁴III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany

,

Fabrizio Cereatti

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

,

Naoki Akizue

⁵Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan

,

Michela Di Fonzo

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

,

Manuela Coppola

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

,

Federico Barbaro

³UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma

,

Benjamin M. Walter

⁶Department of Gastroenterology, Clinic for Internal Medicine, University Hospital Ulm, Germany

,

Paranjay Sharma

⁷Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy

,

Anna Caruso

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

,

Kenichiro Okimoto

⁵Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan

,

Claudia Antenucci

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

,

Tomoaki Matsumura

⁵Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan

,

Giulia Zerboni

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

,

Cristina Grossi

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

,

Michael Meinikheim

⁴III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany

,

Luigi Giovanni Papparella

³UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma

,

Loredana Correale

⁷Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy

,

Guido Costamagna

³UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma

,

Alessandro Repici

⁷Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy

⁸Humanitas Clinical and Research Center –IRCCS-, Endoscopy Unit, Rozzano, Italy

,

Cristiano Spada

³UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma

,

Helmut Messmann

⁴III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany

,

Cesare Hassan

⁷Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy

⁸Humanitas Clinical and Research Center –IRCCS-, Endoscopy Unit, Rozzano, Italy

,

Federico Iacopini

¹Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

› Author Affiliations

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.

Full Text

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Supplementary Material

Supplementary material