Texture and color enhancement imaging versus white light imaging for the detection of colorectal adenomas: a systematic review and meta-analysis

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Background 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 to conventional white light imaging (WLI), can improve important colonoscopy quality indicators, specifically the adenoma detection rate (ADR) and adenomas per colonoscopy (APC). Methods We searched PubMed, EMBASE, and the Cochrane Central for studies comparing TXI to WLI in patients undergoing colonoscopy for any indication. Risk ratios (RR) and mean differences (MD) were computed using a random-effects model. Results We included 1541 patients from 3 studies, of which 2 were randomized controlled trials (RCTs). TXI was used in 775 (50.3%) patients. The 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% 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 to 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 the detection of colorectal adenomas in patients undergoing colonoscopy for various indications. TXI has the potential to improve the overall quality of colonoscopy and contribute to colorectal cancer prevention.