Additional 30-second observation of the right-sided colon for missed polyp detection with texture and color enhancement imaging compared to narrow band imaging: A randomized trial.

Abstract

The efficacy of texture and color enhancement imaging (TXI) in the novel light-emitting diode (LED) endoscopic system for polyp detection has not been examined. We aimed to evaluate the non-inferiority of the additional 30-second (Add-30-s) observation of the right-sided colon (cecum/ascending colon) with TXI compared to narrow band imaging (NBI) for detecting missed polyps. We enrolled 381 patients ≥40 years old who underwent colonoscopy from September 2021 to June 2022 in three institutions and randomly assigned them to either the TXI or NBI groups. The right-sided colon was first observed with white light imaging (WLI) in both groups. Secondly, after re-insertion from hepatic flexure to the cecum, the right-sided colon was observed with Add-30-s observation of either TXI or NBI. The primary endpoint was to examine the non-inferiority of TXI to NBI using the mean number of adenomas and sessile serrated lesions (SSL) per patient (MASP). The secondary ones were to examine adenoma detection rate (ADR), adenoma, and SSL detection rates (ASDR), and polyp detection rates (PDR) in both groups. The TXI and NBI groups consisted of 177 and 181 patients, respectively, and the non-inferiorities of the MASPs in the second observation were significant (TXI 0.29 (51/177) vs. NBI 0.30 (54/181), p<0.01). The change in ADR, ASDR, and PDR for the right-sided colon between the TXI and NBI groups were not different (10.2%/10.5% (p=0.81), 13.0%/12.7% (p=0.71), and 15.3%/13.8% (p=0.71), respectively. Regarding add-30-s observation of the right-sided colon, TXI was non-inferior to NBI.