Texture and Colour Enhancing Imaging versus High-Definition White Light Endoscopy for Detection of Colorectal Neoplasia: a Randomised Trial.

BACKGROUND Texture-and-Color-Enhancing-Imaging(TXI, Olympus, Japan) was recently proposed as a substitute to standard high-definition white-light(WLI) to increase lesion detection during colonoscopy. We performed an international, multicenter randomized trial to assess the efficacy of TXI in detection of colorectal neoplasia. METHODS We enrolled consecutive patients ≥40 years old undergoing screening, surveillance or diagnostic colonoscopies at 5 centers (Italy, Germany, Japan) from September 2021 through May 2022. Patients were randomly assigned (1:1) to TXI or WLI (controls). Primary outcome was Adenoma Detection Rate(ADR). Secondary outcomes were adenomas per colonoscopy(APC) and withdrawal time. Adjusted Relative Risks (RR) for age, sex and colonoscopy indication were calculated. RESULTS We enrolled 747 patients, men: 50.2%, mean age 62.3 ±9.5 years. ADR was significantly higher in the TXI group (221/375, 58.9%) versus WLI group (159/372, 42.7%; adjustedRR:1.38[95%CI:1.20-1.59]). This was significant both for ≤5mm (RR:1.42[1.16-1.73]) and 6-9mm (RR:1.36[1.01-1.83]) adenomas. A higher proportion of both polypoid (151/375, 40.3% vs. 104/372, 28%; RR:1.43[1.17-1.75]) and non-polypoid adenomas (136/375, 36.3% vs. 102/372, 27.4%; RR:1.30[1.05-1.61]) and both 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 [25.6%], RR, 1.46 [1.18-1.80]) lesions were found in the TXI group. APC was higher in the TXI group (1.36 ±1.79 vs 0.89 ±1.35; incident rate ratio, 1.53[1.25-1.88]). CONCLUSIONS In a randomised trial, TXI increased ADR and APC among unselected patients undergoing colonoscopy for various indications. TXI increased detection of polyps <10mm in size, both in the proximal and in the distal colon, and may help to increase colonoscopy quality indicators.