Subscribe to RSS

DOI: 10.1055/a-2474-9676
Texture and color enhancement imaging versus white light imaging for the detection of colorectal adenomas: Systematic review and meta-analysis

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 cancerPublication 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
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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 10 Sato T. TXI: Texture and color enhancement imaging for endoscopic image enhancement. J Healthc Eng 2021; 2021: 5518948
- 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
-
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
- 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
- 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
-
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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 26 Kaminski MF, Regula J. Adenoma detection race at colonoscopy: The good and the bad. Gastroenterology 2015; 149: 273-274
- 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
- 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
- 29 Crockett SD, Nagtegaal ID. Terminology, molecular features, epidemiology, and management of serrated colorectal neoplasia. Gastroenterology 2019; 157: 949-966 e4
- 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
- 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
- 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
- 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