Assessing the effectiveness of texture and color enhancement imaging versus white-light endoscopy in detecting gastrointestinal lesions: A systematic review and meta-analysis

Abstract

Introduction: Gastrointestinal cancers account for 26% of cancer incidence and 35% of cancer-related deaths globally. Early detection is crucial but often limited by white light endoscopy (WLE), which misses subtle lesions. Texture and color enhancement imaging (TXI), introduced in 2020, enhances texture, brightness, and color, addressing WLE's limitations. This meta-analysis evaluates TXI's effectiveness compared to WLE in gastrointestinal lesion lesion detection.

Methods: A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of CENTRAL, PubMed, Embase, and Web of Science identified randomized controlled trials and observational studies comparing TXI with WLE. Outcomes included lesion detection rates, color differentiation, and visibility scores. The risk of bias was assessed using the Cochrane ROB 2.0 tool and Newcastle-Ottawa tools, and evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation.

Results: Seventeen studies with 16,634 participants were included. TXI significantly improved color differentiation (mean difference: 3.31, 95% confidence interval [CI]: 2.49-4.13), visibility scores (mean difference: 0.50, 95% CI: 0.36-0.64), and lesion detection rates (odds ratio [OR]: 1.84, 95% CI: 1.52-2.22) compared to WLE. Subgroup analyses confirmed TXI's advantages across pharyngeal, esophageal, gastric, and colorectal lesions. TXI also enhanced adenoma detection rates (OR: 1.66, 95% CI: 1.31-2.12) and mean adenoma detection per procedure (mean difference: 0.48, 95% CI: 0.25-0.70).

Conclusion: TXI improves gastriontestinal lesion lesion detection by enhancing visualization and color differentiation, addressing key limitations of WLE. These findings support its integration into routine endoscopy, with further research needed to compare TXI with other modalities and explore its potential in real-time lesion detection.

Keywords: diagnostic imaging; early detection of cancer; gastrointestinal endoscopy; gastrointestinal neoplasms; image enhancement.

FIGURE 1

Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram. Study selection process following PRISMA guidelines. The flow diagram outlines identification, screening, eligibility, and inclusion stages, with reasons for exclusion at various stages.

FIGURE 2

Risk of bias (ROB) assessment. Risk of bias assessment of included studies categorized into key domains, summarizing the overall methodological quality of the studies included in the analysis.

FIGURE 3

Forest plot for primary outcome: color difference. Forest plot showing the pooled analysis of the color difference between lesions and surrounding mucosa for texture and color enhancement imaging (TXI) versus white light endoscopy (WLE). The plot presents mean differences, 95% confidence intervals, and heterogeneity statistics.

FIGURE 4

Forest plot for visibility scores by lesion type. Pooled analysis of visibility scores stratified by lesion type, including colorectal, gastric, and esophageal lesions. Forest plots display mean differences, confidence intervals, and heterogeneity measures for texture and color enhancement imaging (TXI) versus white light endoscopy (WLE).

FIGURE 5

Forest plot for gastrointestinal lesion detection rate by lesion location. Forest plot showing the gastrointestinal lesion detection rates stratified by lesion location: pharyngeal and esophageal lesions, gastric lesions, and colorectal lesions. Odds ratios and 95% confidence intervals are presented for each subgroup, with significant advantages for texture and color enhancement imaging (TXI) observed in gastric and colorectal lesions.

FIGURE 6

Forest plot: comparison of texture and color enhancement imaging (TXI)‐mode 1 vs TXI‐mode 2. Forest plot presenting pooled mean differences comparing TXI‐Mode 1 and TXI‐Mode 2 for color differentiation and lesion visibility scores, highlighting the superiority of TXI‐Mode 1.

FIGURE 7

Forest plot: experts versus trainees in lesion visibility. Forest plot comparing lesion visibility scores between expert endoscopists and trainees/novices using texture and color enhancement imaging (TXI), demonstrating similar effectiveness across different levels of endoscopic experience.