Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a24749676
DOI: 10.1055/a-2474-9676
Review

Texture and color enhancement imaging versus white light imaging for the detection of colorectal adenomas: Systematic review and meta-analysis

Stefan Mitev 
1   Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria (Ringgold ID: RIN266309)
,
Humza Saeed 
2   Gastroenterology, Rawalpindi Medical University, Rawalpindi, Pakistan (Ringgold ID: RIN123683)
,
Ch Faizan Rasheed
2   Gastroenterology, Rawalpindi Medical University, Rawalpindi, Pakistan (Ringgold ID: RIN123683)
,
A Abdullah 
2   Gastroenterology, Rawalpindi Medical University, Rawalpindi, Pakistan (Ringgold ID: RIN123683)
,
Stefan Murvakov
3   HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria, Sofia, Bulgaria
,
Vassil Sirakov
3   HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria, Sofia, Bulgaria
,
Stefan Tchernodrinski
4   Division of Academic Internal Medicine and Geriatrics, University of Illinois Chicago, Chicago, United States (Ringgold ID: RIN14681)
,
Zoya Spassova
1   Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria (Ringgold ID: RIN266309)
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims

Texture and color enhancement imaging (TXI) is a novel optical technology designed to improve visibility during endoscopy by highlighting subtle differences in morphology and color. This systematic review and meta-analysis aimed to determine whether TXI, compared with conventional white light imaging (WLI), can improve important colonoscopy quality indicators, specifically the adenoma detection rate (ADR) and adenomas per colonoscopy (APC).

Patients and methods

We searched PubMed, EMBASE, and the Cochrane Central for studies comparing TXI to WLI in patients undergoing colonoscopy for any indication. Risk ratios (RRs) and mean differences (MDs) were computed using a random-effects model.

Results

We included 1541 patients from three studies, of which two were randomized controlled trials (RCTs). TXI was used in 775 patients (50.3%). Indications for colonoscopy varied, including positive fecal immunochemical test (FIT), surveillance, and diagnostic workup for abdominal symptoms. In the pooled data, TXI significantly increased both ADR (57,8% versus 43.6%; RR 1.32; 95% confidence interval [CI] 1.20-1.46; P < 0.001; I2 = 0%) and APC (MD 0.50; 95% CI 0.37-0.64; P < 0.001; I2 = 0%), compared with WLI. Furthermore, TXI was more effective at detecting nonpolypoid/flat adenomas, proximal/right-sided adenomas, and adenomas ≥ 10 mm in size. Colonoscopies with TXI had shorter withdrawal times.

Conclusions

Our meta-analysis demonstrates that TXI significantly improves detection of colorectal adenomas in patients undergoing colonoscopy for various indications. TXI has the potential to improve overall quality of colonoscopy and contribute to colorectal cancer prevention.

Keywords

Endoscopy Lower GI Tract - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE...) - Polyps / adenomas / ... - Colorectal cancer

Supplementary Material



Publication History

Received: 16 July 2024

Accepted after revision: 13 November 2024

Accepted Manuscript online:
18 November 2024

Article published online:
13 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Stefan Mitev, Humza Saeed, Ch Faizan Rasheed, A Abdullah, Stefan Murvakov, Vassil Sirakov, Stefan Tchernodrinski, Zoya Spassova. Texture and color enhancement imaging versus white light imaging for the detection of colorectal adenomas: Systematic review and meta-analysis. Endosc Int Open 2025; 13: a24749676.
DOI: 10.1055/a-2474-9676
 

  • References

  • 1 Baidoun F, Elshiwy K, Elkeraie Y. et al. Colorectal Cancer epidemiology: Recent trends and impact on outcomes. Curr Drug Targets 2021; 22: 998-1009
    Search in Google Scholar
  • 2 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
    Search in Google Scholar
  • 3 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
    Search in Google Scholar
  • 4 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
    Search in Google Scholar
  • 5 Keswani RN, Crockett SD, Calderwood AH. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology 2021; 161: 701-711
    Search in Google Scholar
  • 6 Ishtiaq R, Zulfiqar L, Gangwani MK. et al. Adenoma detection rate vs. adenoma per colonoscopy as quality indicators for colon cancer screening. Transl Gastroenterol Hepatol 2023; 8: 24
    Search in Google Scholar
  • 7 Sakamoto T, Ikematsu H, Tamai N. et al. Detection of colorectal adenomas with texture and color enhancement imaging: Multicenter observational study. Dig Endosc 2023; 35: 529-537
    Search in Google Scholar
  • 8 Wang S, Kim AS, Church TR. et al. Adenomas per colonoscopy and adenoma per positive participant as quality indicators for screening colonoscopy. Endosc Int Open 2020; 8: E1560-E1565
    Search in Google Scholar
  • 9 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
    Search in Google Scholar
  • 10 Sato T. TXI: Texture and color enhancement imaging for endoscopic image enhancement. J Healthc Eng 2021; 2021: 5518948
    Search in Google Scholar
  • 11 Nagai M, Suzuki S, Minato Y. et al. Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials. Clin Endosc 2023; 56: 553-562
    Search in Google Scholar
  • 12 Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. Higgins J, Thomas J, Chandler J. https://www.training.cochrane.org/handbook
  • 13 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    Search in Google Scholar
  • 14 Higgins JPT, Altman DG, Gøtzsche PC. et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    Search in Google Scholar
  • 15 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919
    Search in Google Scholar
  • 16 Cochrane Training. RevMan Calculator. https://training.cochrane.org/resource/revman-calculator
  • 17 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    Search in Google Scholar
  • 18 Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959; 22: 719-748
    Search in Google Scholar
  • 19 Antonelli G, Bevivino G, Pecere S. et al. Texture and color enhancement imaging versus high definition white-light endoscopy for detection of colorectal neoplasia: a randomized trial. Endoscopy 2023; 55: 1072-1080
    Search in Google Scholar
  • 20 Young E, Rajagopalan A, Tee D. et al. Texture and color enhancement imaging improves colonic adenoma detection: A multicenter randomized controlled trial. Gastroenterology 2024; 166: 338-340 e3
    Search in Google Scholar
  • 21 Tamai N, Horiuchi H, Matsui H. et al. Visibility evaluation of colorectal lesion using texture and color enhancement imaging with video. DEN Open 2022; 2: e90
    Search in Google Scholar
  • 22 Okumura T, Hotta K, Imai K. et al. Efficacy of texture and color enhancement imaging for the visibility and diagnostic accuracy of non-polypoid colorectal lesions. DEN Open 2024; 5: e380
    Search in Google Scholar
  • 23 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
    Search in Google Scholar
  • 24 Sun Y, Lv X-H, Zhang X. et al. Linked color imaging versus white light imaging in the diagnosis of colorectal lesions: a meta-analysis of randomized controlled trials. Therap Adv Gastroenterol 2023; 16
    Search in Google Scholar
  • 25 Aziz M, Ahmed Z, Haghbin H. et al. Does i-scan improve adenoma detection rate compared to high-definition colonoscopy? A systematic review and meta-analysis. Endosc Int Open 2022; 10: E824-E831
    Search in Google Scholar
  • 26 Kaminski MF, Regula J. Adenoma detection race at colonoscopy: The good and the bad. Gastroenterology 2015; 149: 273-274
    Search in Google Scholar
  • 27 Vleugels JLA, Hassan C, Senore C. et al. Diminutive polyps with advanced histologic features do not increase risk for metachronous advanced colon neoplasia. Gastroenterology 2019; 156: 623-634 e3
    Search in Google Scholar
  • 28 Barclay RL, Vicari JJ, Doughty AS. et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
    Search in Google Scholar
  • 29 Crockett SD, Nagtegaal ID. Terminology, molecular features, epidemiology, and management of serrated colorectal neoplasia. Gastroenterology 2019; 157: 949-966 e4
    Search in Google Scholar
  • 30 Toledo DEFWM van, IJspeert JEG, Bossuyt PMM. et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol 2022; 7: 747-754
    Search in Google Scholar
  • 31 Nishizawa T, Toyoshima O, Yoshida S. et al. TXI (texture and color enhancement imaging) for serrated colorectal lesions. J Clin Med 2021; 11: 119
    Search in Google Scholar
  • 32 Wei J, Zhao S, Bai Y. Impact of texture and color enhancement imaging on adenoma and sessile serrated lesion detection: Much more to explore. Gastroenterology 2024; 167: 413-414
    Search in Google Scholar
  • 33 Cross AJ, Robbins EC, Saunders BP. et al. Higher Adenoma detection rates at screening associated with lower long-term colorectal cancer incidence and mortality. Clin Gastroenterol Hepatol 2022; 20: e148-e167
    Search in Google Scholar