The Efficacy of Texture and Color Enhancement Imaging Observation in the Detection of Colorectal Lesions: A Multicenter, Randomized Controlled Trial (deTXIon Study)

Abstract

Background & aims: Colonoscopy is the gold standard for detecting and resecting adenomas and early-stage cancers to reduce colorectal cancer (CRC) incidence and mortality rates. This study aimed to confirm the superiority of texture and color enhancement imaging (TXI) over white light imaging (WLI) in detecting colorectal lesions.

Methods: This randomized controlled trial was conducted at 8 Japanese institutions between March 2023 and October 2023. Participants aged 40 to 80 years old scheduled for CRC screening and nonscreening purposes, such as postpolypectomy surveillance, positive fecal occult blood test results, and abdominal symptoms, were included. We used only the latest model colonoscopes and performed observations in each arm of the TXI mode 1 and WLI. The primary end point was the mean number of adenomas detected per procedure. Secondary end points included the adenoma detection rate, polyp detection rate, flat polyp detection rate, and adverse events.

Results: A total of 956 patients were enrolled and randomized. After patients who did not meet the eligibility criteria were excluded, 451 and 445 patients were included in the TXI and WLI arms, respectively. The mean number of adenomas detected per procedure was 1.4 and 1.5 and the adenoma detection rate was 57.2% and 56.0% in TXI and WLI, respectively, and there were no statistically significant differences between 2 arms. The polyp detection rate and flat polyp detection rate were significantly higher in TXI than in WLI, which were 82.5% vs 74.4% (P = .003), and 76.5% vs 70.3% (P = .036), respectively.

Conclusions: This study did not demonstrate the superiority of TXI over WLI in detecting neoplastic lesions. However, TXI may be effective in detecting flat polyps. (Clinical trial registration: jRCT1032230089.).

Keywords: Colonoscopy; Colorectal Cancer; Colorectal Polyp; Detection; Image Enhancement.