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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

 

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