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Shahzil M, Kashif TB, Jamil Z, Khaqan MA, Munir L, Amjad Z, Faisal MS, Chaudhary AJ, Ali H, Khan S, Enofe I. Assessing the effectiveness of texture and color enhancement imaging versus white-light endoscopy in detecting gastrointestinal lesions: A systematic review and meta-analysis. DEN OPEN 2026; 6:e70128. [PMID: 40313348 PMCID: PMC12044138 DOI: 10.1002/deo2.70128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Revised: 03/31/2025] [Accepted: 04/16/2025] [Indexed: 05/03/2025]
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.
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Affiliation(s)
- Muhammad Shahzil
- Department of Internal MedicineMilton S Hershey Medical CenterThe Pennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Talha Bin Kashif
- Department of Internal MedicineKing Edward Medical University, Neela GumbadLahorePakistan
| | - Zainab Jamil
- Department of Internal MedicineKing Edward Medical University, Neela GumbadLahorePakistan
| | - Muhammad Ali Khaqan
- Department of Gastroenterology and HepatologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Luqman Munir
- Department of Internal MedicineKing Edward Medical University, Neela GumbadLahorePakistan
| | - Zunaira Amjad
- Department of Internal MedicineServices Institute of Medical SciencesLahorePakistan
| | | | | | - Hassam Ali
- Department of Gastroenterology and HepatologyECU HealthGreenvilleNorth CarolinaUSA
| | - Shahryar Khan
- Department of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Ikponmwosa Enofe
- Department of Gastroenterology and HepatologyMilton S. Hershey Medical CenterThe Pennsylvania State UniversityHersheyPennsylvaniaUSA
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Nigam GB, East JE. Improved DeTXIon Is Harder When White Light Colonoscopy Gets a Stable Extended Depth of Field. Gastroenterology 2025:S0016-5085(25)00642-0. [PMID: 40286942 DOI: 10.1053/j.gastro.2025.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2025] [Accepted: 04/14/2025] [Indexed: 04/29/2025]
Affiliation(s)
- Gaurav B Nigam
- Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James E East
- Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
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Utsunomiya H, Ueyama H, Takeda T, Nakamura S, Uemura Y, Iwano T, Yamamoto M, Uchida R, Abe D, Oki S, Suzuki N, Ikeda A, Akazawa Y, Ueda K, Hojo M, Nojiri S, Yao T, Nagahara A. Visibility evaluation of gastric epithelial neoplasm of fundic gland mucosa lineage using texture and color enhancement imaging. DEN OPEN 2025; 5:e70110. [PMID: 40200959 PMCID: PMC11977659 DOI: 10.1002/deo2.70110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 03/06/2025] [Accepted: 03/21/2025] [Indexed: 04/10/2025]
Abstract
Objectives Recently, the incidence of Helicobacter pylori-uninfected gastric cancers, such as gastric epithelial neoplasm of fundic-gland mucosa lineage (GEN-FGML), has increased with the widespread use of eradication therapy. Because the detection and endoscopic diagnosis of GEN-FGML are difficult, an effective observation method in screening endoscopy is required. We investigated whether texture and color enhancement imaging (TXI) improved the visibility of GEN-FGML compared with white light imaging (WLI). Methods In this single-center prospective clinical study, 50 GEN-FGML lesions (35 patients) treated at our hospital between October 2020 and June 2023 were analyzed. The endoscopic images of GEN-FGML obtained using WLI, TXI mode 1 (TXI-1), TXI mode 2 (TXI-2), and narrow-band imaging were compared by 10 endoscopists. We analyzed the visibility score and inter-rater reliability (intraclass correlation coefficient and conducted an objective evaluation based on L* a* b* color values and the color difference (ΔE*) in the CIE LAB color space system. Results Histologically, GEN-FGML was classified as gastric adenocarcinoma of fundic-gland type (n = 45) and gastric adenocarcinoma of fundic-gland mucosa type (n = 5). The total visibility score for all endoscopists was significantly higher for TXI than for WLI (p < 0.01); and for TXI-1 than for TXI-2 (p < 0.01). The intraclass correlation coefficients for TXI-1 and TXI-2 were "almost perfect" and "substantial," respectively, for all endoscopists. ΔE* was significantly higher for TXI than for WLI (p < 0.01). Conclusions TXI improved the visibility of GEN-FGML for all endoscopists compared with WLI when evaluated subjectively and objectively.
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Affiliation(s)
- Hisanori Utsunomiya
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Hiroya Ueyama
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Tsutomu Takeda
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Shunsuke Nakamura
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Yasuko Uemura
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Tomoyo Iwano
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Momoko Yamamoto
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Ryota Uchida
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Daiki Abe
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Shotaro Oki
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Nobuyuki Suzuki
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Atsushi Ikeda
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Yoichi Akazawa
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Kumiko Ueda
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Mariko Hojo
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Shuko Nojiri
- Medical Technology Innovation CenterJuntendo University School of MedicineTokyoJapan
| | - Takashi Yao
- Department of Human PathologyJuntendo University Graduate School of MedicineTokyoJapan
| | - Akihito Nagahara
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
- Department of Pathophysiological Research and Therapeutics for Gastrointestinal DiseaseJuntendo University School of MedicineTokyoJapan
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Kato T, Hikichi T, Nakamura J, Hashimoto M, Kobashi R, Yanagita T, Takagi T, Suzuki R, Sugimoto M, Asama H, Sato Y, Shioya Y, Kobayakawa M, Ohira H. Visibility of esophageal squamous cell carcinoma under iodine staining on texture and color enhancement imaging. DEN OPEN 2025; 5:e370. [PMID: 38725874 PMCID: PMC11079435 DOI: 10.1002/deo2.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Iodine staining on white light imaging (WLI) is the gold standard for detecting and demarcating esophageal squamous cell carcinoma (ESCC). We examined the effects of texture and color enhancement imaging (TXI) on improving the endoscopic visibility of ESCC under iodine staining. METHODS Twenty ESCC lesions that underwent endoscopic submucosal dissection were retrospectively included. The color difference between ESCC and the surrounding mucosa (ΔEe) on WLI, TXI, and narrow-band imaging was assessed, and ΔEe under 1% iodine staining on WLI and TXI. Furthermore, the visibility grade determined by endoscopists was evaluated on each imaging. RESULT The median ΔEe was greater on TXI than on WLI (14.53 vs. 10.71, respectively; p < 0.005). Moreover, the median ΔEe on TXI under iodine staining was greater than the median ΔEe on TXI and narrow-band imaging (39.20 vs. 14.53 vs. 16.42, respectively; p < 0.005 for both). A positive correlation in ΔEe under iodine staining was found between TXI and WLI (correlation coefficient = 0.61, p < 0.01). Moreover, ΔEe under iodine staining on TXI in each lesion was greater than the corresponding ΔEe on WLI. The visibility grade assessed by endoscopists on TXI was also significantly greater than that on WLI under iodine staining (p < 0.01). CONCLUSIONS The visibility of ESCC after iodine staining was greater on TXI than on WLI.
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Affiliation(s)
- Tsunetaka Kato
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Jun Nakamura
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Minami Hashimoto
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Ryoichiro Kobashi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takumi Yanagita
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Tadayuki Takagi
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Rei Suzuki
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Mitsuru Sugimoto
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Hiroyuki Asama
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yuki Sato
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yasuo Shioya
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Masao Kobayakawa
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Medical Research CenterFukushima Medical UniversityFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
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Toyoshima N, Mizuguchi Y, Takamaru H, Nakamura K, Kakugawa Y, Sakamoto T, Shiroyama M, Kawagoe R, Tsuchiya K, Shinmura K, Ikematsu H, Inaba A, Minakata N, Hotta K, Imai K, Takada K, Ito S, Misawa M, Wakamura K, Kudo SE, Tamai N, Sumiyama K, Ito M, Uraoka T, Tomaru S, Matsuda T, Fujimoto A, Shibata T, Saito Y. The Efficacy of Texture and Color Enhancement Imaging Observation in the Detection of Colorectal Lesions: A Multicenter, Randomized Controlled Trial (deTXIon Study). Gastroenterology 2025:S0016-5085(25)00524-4. [PMID: 40113100 DOI: 10.1053/j.gastro.2025.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 02/04/2025] [Accepted: 03/01/2025] [Indexed: 03/22/2025]
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 model 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.
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Affiliation(s)
- Naoya Toyoshima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Keiko Nakamura
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuo Kakugawa
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Department of Gastroenterology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Mamiko Shiroyama
- Department of Gastroenterology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Ryosuke Kawagoe
- Department of Gastroenterology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Atsushi Inaba
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Nobuhisa Minakata
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Mamoru Ito
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shota Tomaru
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takahisa Matsuda
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Ai Fujimoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Taro Shibata
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
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Mitev S, Saeed H, Rasheed CF, Abdullah A, Murvakov S, Sirakov V, Tchernodrinski S, Spassova Z. Texture and color enhancement imaging versus white light imaging for the detection of colorectal adenomas: Systematic review and meta-analysis. Endosc Int Open 2025; 13:a24749676. [PMID: 39958660 PMCID: PMC11827751 DOI: 10.1055/a-2474-9676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 11/13/2024] [Indexed: 02/18/2025] Open
Abstract
Background and study aims 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 with conventional white light imaging (WLI), can improve important colonoscopy quality indicators, specifically the adenoma detection rate (ADR) and adenomas per colonoscopy (APC). Patients and methods We searched PubMed, EMBASE, and the Cochrane Central for studies comparing TXI to WLI in patients undergoing colonoscopy for any indication. Risk ratios (RRs) and mean differences (MDs) were computed using a random-effects model. Results We included 1541 patients from three studies, of which two were randomized controlled trials (RCTs). TXI was used in 775 patients (50.3%). 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% confidence interval [CI] 1.20-1.46; P < 0.001; I 2 = 0%) and APC (MD 0.50; 95% CI 0.37-0.64; P < 0.001; I 2 = 0%), compared with 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 detection of colorectal adenomas in patients undergoing colonoscopy for various indications. TXI has the potential to improve overall quality of colonoscopy and contribute to colorectal cancer prevention.
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Affiliation(s)
- Stefan Mitev
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Humza Saeed
- Gastroenterology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Ch Faizan Rasheed
- Gastroenterology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - A Abdullah
- Gastroenterology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Stefan Murvakov
- HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria, Sofia, Bulgaria
| | - Vassil Sirakov
- HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria, Sofia, Bulgaria
| | - Stefan Tchernodrinski
- Division of Academic Internal Medicine and Geriatrics, University of Illinois Chicago, Chicago, United States
| | - Zoya Spassova
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria
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7
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Nabi Z, Reddy DN. Therapeutic endoscopy: Recent updates and future directions. Dig Liver Dis 2024; 56:1810-1818. [PMID: 38584031 DOI: 10.1016/j.dld.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024]
Abstract
The landscape of therapeutic endoscopy has undergone a remarkable evolution over the past few decades, carving out a niche that merges innovative technology with advanced clinical practice. As we venture further into the 21st century, the horizon of this field continues to expand, driven by rapid advancements in technology and a deeper understanding of gastrointestinal pathology. This review article aims to shed light on the recent advances and future trajectories of therapeutic endoscopy, focusing on pivotal areas such as third space endoscopy, endoscopic resection techniques, artificial endoscopy, endoscopic ultrasound (EUS), the integration of artificial intelligence (AI), and endoscopic anti-reflux therapies.
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Affiliation(s)
- Zaheer Nabi
- Consultant Gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India.
| | - D Nageshwar Reddy
- Chairman and Chief Gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India.
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Toyoshima O, Nishizawa T, Hiramatsu T, Matsuno T, Yoshida S, Mizutani H, Ebinuma H, Matsuda T, Saito Y, Fujishiro M. Colorectal adenoma detection rate using texture and color enhancement imaging versus white light imaging with chromoendoscopy: a propensity score matching study. J Gastroenterol Hepatol 2024; 39:2105-2111. [PMID: 38872367 DOI: 10.1111/jgh.16655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/07/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND AIM Few studies have evaluated the adenoma detection rate (ADR) of colonoscopy with texture and color enhancement imaging (TXI), a novel image-enhancing technology. This study compares the detection of colorectal polyps using TXI to that using white light imaging (WLI). METHODS This single-center retrospective study used propensity-matched scoring based on the patients' baseline characteristics (age, sex, indication, bowel preparation, endoscopist, colonoscope type, and withdrawal time) to compare the results of patients who underwent chromoendoscopy using WLI or TXI at the Toyoshima Endoscopy Clinic. The differences in polyp detection rates and the mean number of detected polyps per colonoscopy were determined between the TXI and WLI groups. RESULTS After propensity score matching, 1970 patients were enrolled into each imaging modality group. The mean patient age was 57.2 ± 12.5 years, and 44.5% of the cohort were men. The ADR was higher in the TXI group than in the WLI group (55.0% vs 49.4%, odds ratio: 1.25). High-risk ADR were more common in the TXI group than in the WLI group (17.6% vs 12.8%; OR: 1.45). The mean number of adenomas per colonoscopy (APC) was higher in the TXI group than in the WLI group (1.187 vs 0.943, OR: 1.12). APC with a flat morphology (1.093 vs 0.848, OR: 1.14) and APC of <6 mm (0.992 vs 0.757, OR: 1.16) were higher in the TXI group than in the WLI group. CONCLUSION Compared to WLI, TXI improved the ADR in patients who underwent chromoendoscopy based on actual clinical data.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Takuma Hiramatsu
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Matsuno
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
| | - Shuntaro Yoshida
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Internal Medicine, Yoshida Clinic, Fukaya, Japan
| | - Hiroya Mizutani
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotoshi Ebinuma
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | | | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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9
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Nagarajan KV, Bhat N. Imaging colonic polyps in 2024. Indian J Gastroenterol 2024; 43:954-965. [PMID: 39347933 DOI: 10.1007/s12664-024-01679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/19/2024] [Indexed: 10/01/2024]
Abstract
Screening colonoscopy and polypectomy are the cornerstone in decreasing the incidence and mortality of colorectal cancer. Despite the low incidence of colorectal cancer in India, there has been a rising trend in the incidence of colonic polyps and cancer over the last decade. It is, hence, imperative that we are well equipped in the management of colonic polyps. Adequate training in the detection and characterization of polyps to aid in their management is necessary. Detection of polyps can be increased by adhering to the standards of colonoscopy, including good bowel preparation, cecal intubation rate, adequate withdrawal time and use of distal attachment devices. A detected polyp needs optimal characterization to predict histology in real time and decide on the management strategies. Characterization of the polyps requires high-definition-white light endoscopy and/or image-enhanced endoscopy (dye based or digital). Various factors that help in predicting histology include size, location and morphology of the polyp and the pit pattern, vascular and surface pattern of the polyp. Polyps can be differentiated as neoplastic or non-neoplastic with reasonable accuracy with the above features. Prediction of advanced pathology including high-grade dysplasia and deep sub-mucosal invasion is essential, as it helps in deciding if the lesion is amenable to endotherapy and the technique of endoscopic resection. Adequate training in image-enhanced endoscopy is necessary to assess advanced pathology in polyps. Technology pertaining to image-enhanced endoscopy includes narrow banding imaging and blue laser imaging; newer variations are being introduced every few years making it necessary to be abreast with growing information. The recent advances in gastrointestinal (GI) endoscopy with the advent of endocytoscopy and artificial intelligence seem promising and are predicted to be the future of GI endoscopy.
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Affiliation(s)
- Kayal Vizhi Nagarajan
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Aster CMI Hospital, Bengaluru, 560 092, India
| | - Naresh Bhat
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Aster CMI Hospital, Bengaluru, 560 092, India.
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Saito Y, Toyoshima N, Mizuguchi Y, Sakamoto T, Uraoka T, Ikematsu H, Tamai N, Matsuda T, Misawa M, Hotta K, Shibata T. Protocol for a prospective multicenter randomized controlled trial to evaluate the efficacy of texture and color enhancement imaging (TXI) observation in the detection of colorectal lesions (deTXIon study). Jpn J Clin Oncol 2024; 54:1052-1056. [PMID: 38762330 DOI: 10.1093/jjco/hyae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/30/2024] [Indexed: 05/20/2024] Open
Abstract
Colonoscopy is the gold standard for detecting and resecting adenomas or early stage cancers to reduce the incidence and mortality rates of colorectal cancer. In a recent observational study, texture and color enhancement imaging (TXI) was reported to improve polyp detection during colonoscopy. This randomized controlled trial involving six Japanese institutions aims to confirm the superiority of TXI over standard white-light imaging (WLI) in detecting colorectal lesions during colonoscopy. During the 1-year study period, 960 patients will be enrolled, with 480 patients in the TXI and WLI groups. The primary endpoint is the mean number of adenomas detected per procedure. The secondary endpoints include adenoma detection rate, advanced adenoma detection rate, polyp detection rate, flat polyp detection rate, depressed lesion detection rate, mean polyps detected per procedure, sessile serrated lesion (SSL) detection rate, mean SSLs detected per procedure and adverse events.
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Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Toyoshima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Taku Sakamoto
- Department of Gastroenterology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Department of Gastroenterology and Endoscopy, National Ccccancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Naoto Tamai
- Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Taro Shibata
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
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Sakai H, Iwai N, Dohi O, Oka K, Okuda T, Tsuji T, Okabe K, Ohara T, Kajiwara-Kubtota M, Fukui H, Sakagami J, Kagawa K, Inoue K, Yoshida N, Uchiyama K, Takagi T, Konishi H, Itoh Y. Effect of texture and color enhancement imaging on the visibility of gastric tumors. Sci Rep 2024; 14:19125. [PMID: 39155293 PMCID: PMC11330958 DOI: 10.1038/s41598-024-70236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/14/2024] [Indexed: 08/20/2024] Open
Abstract
Texture and color enhancement imaging (TXI) may improve the visibility of gastric tumors and allow their early detection. However, few reports have examined the utility of TXI. Between June 2021 and October 2022, 56 gastric tumors in 51 patients undergoing endoscopic submucosal dissection at Fukuchiyama City Hospital were evaluated preoperatively using conventional white light imaging (WLI), narrow-band imaging (NBI), and TXI modes 1 and 2. The color differences of the tumors and surrounding mucosae were evaluated using the CIE 1976 L*a*b color space, Additionally, the visibility scores were scaled. Of the 56 gastric tumors, 45 were early gastric cancers, and 11 were adenomas. Overall, the color difference in TXI mode 1 was considerably higher compared to WLI (16.36 ± 7.05 vs. 10.84 ± 4.05; p < 0.01). Moreover, the color difference in early gastric cancers was considerably higher in TXI mode 1 compared to WLI, whereas no significant difference was found in adenomas. The visibility score in TXI mode 1 was the highest, and it was significantly higher compared to WLI. Regarding adenomas, the visibility score in TXI mode 1 was also significantly higher compared to that in WLI. TXI may provide improved gastric tumor visibility.
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Affiliation(s)
- Hiroaki Sakai
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Naoto Iwai
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kohei Oka
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Okuda
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshifumi Tsuji
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Kengo Okabe
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomoya Ohara
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Mariko Kajiwara-Kubtota
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Hayato Fukui
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Junichi Sakagami
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Keizo Kagawa
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Ken Inoue
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohisa Yoshida
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiko Uchiyama
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
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12
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Wei J, Zhao S, Bai Y. Impact of Texture and Color Enhancement Imaging on Adenoma and Sessile Serrated Lesion Detection: Much More to Explore. Gastroenterology 2024; 167:413-414. [PMID: 38224857 DOI: 10.1053/j.gastro.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Jiahui Wei
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shengbing Zhao
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
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13
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Toyoshima O, Nishizawa T, Hata K. Topic highlight on texture and color enhancement imaging in gastrointestinal diseases. World J Gastroenterol 2024; 30:1934-1940. [PMID: 38681121 PMCID: PMC11045492 DOI: 10.3748/wjg.v30.i14.1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/03/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Olympus Corporation developed texture and color enhancement imaging (TXI) as a novel image-enhancing endoscopic technique. This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting. A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate (ADR) and the mean number of adenomas per procedure (MAP) of TXI compared with those of white-light imaging (WLI) observation (58.7% vs 42.7%, adjusted relative risk 1.35, 95%CI: 1.17-1.56; 1.36 vs 0.89, adjusted incident risk ratio 1.48, 95%CI: 1.22-1.80, respectively). A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI (1.5 vs 1.0, adjusted odds ratio 1.4, 95%CI: 1.2-1.6; 58.2% vs 46.8%, 1.5, 1.0-2.3, respectively). A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure (0.29 vs 0.30, difference for non-inferiority -0.01, 95%CI: -0.10 to 0.08). A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis. A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI (0.71% vs 0.29%). A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI (69.2% vs 52.5% and 85.3% vs 78.7%, respectively). In conclusion, TXI can improve gastrointestinal lesion detection and qualitative diagnosis. Therefore, further studies on the efficacy of TXI in clinical practice are required.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
| | - Keisuke Hata
- Department of Gastroenterology, Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo 103-0022, Japan
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14
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Gadi SR, Muralidharan SS, Glissen Brown JR. Colonoscopy Quality, Innovation, and the Assessment of New Technology. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2024; 26:177-192. [DOI: 10.1016/j.tige.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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15
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Hiramatsu T, Nishizawa T, Kataoka Y, Yoshida S, Matsuno T, Mizutani H, Nakagawa H, Ebinuma H, Fujishiro M, Toyoshima O. Improved visibility of colorectal tumor by texture and color enhancement imaging with indigo carmine. World J Gastrointest Endosc 2023; 15:690-698. [PMID: 38187913 PMCID: PMC10768041 DOI: 10.4253/wjge.v15.i12.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 11/24/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND Accurate diagnosis and early resection of colorectal polyps are important to prevent the occurrence of colorectal cancer. However, technical factors and morphological factors of polyps itself can lead to missed diagnoses. Image-enhanced endoscopy and chromoendoscopy (CE) have been developed to facilitate an accurate diagnosis. There have been no reports on visibility using a combination of texture and color enhancement imaging (TXI) and CE for colorectal tumors.
AIM To investigate the visibility of margins and surfaces with the combination of TXI and CE for colorectal lesions.
METHODS This retrospective study included patients who underwent lower gastrointestinal endoscopy at the Toyoshima Endoscopy Clinic. We extracted polyps that were resected and diagnosed as adenomas or serrated polyps (hyperplastic polyps and sessile serrated lesions) from our endoscopic database. An expert endoscopist performed the lower gastrointestinal endoscopies and observed the lesion using white light imaging (WLI), TXI, CE, and TXI + CE modalities. Indigo carmine dye was used for CE. Three expert endoscopists rated the visibility of the margin and surface patterns in four ranks, from 1 to 4. The primary outcomes were the average visibility scores for the margin and surface patterns based on the WLI, TXI, CE, and TXI + CE observations. Visibility scores between the four modalities were compared by the Kruskal-Wallis and Dunn tests.
RESULTS A total of 48 patients with 81 polyps were assessed. The histological subtypes included 50 tubular adenomas, 16 hyperplastic polyps, and 15 sessile serrated lesions. The visibility scores for the margins based on WLI, TXI, CE, and TXI + CE were 2.44 ± 0.93, 2.90 ± 0.93, 3.37 ± 0.74, and 3.75 ± 0.49, respectively. The visibility scores for the surface based on WLI, TXI, CE, and TXI + CE were 2.25 ± 0.80, 2.84 ± 0.84, 3.12 ± 0.72, and 3.51 ± 0.60, respectively. The visibility scores for the detection and surface on TXI were significantly lower than that on CE but higher than that on WLI (P < 0.001). The visibility scores for the margin and surface on TXI + CE were significantly higher than those on CE (P < 0.001). In the sub-analysis of adenomas, the visibility for the margin and surface on TXI + CE was significantly better than that on WLI, TXI, and CE (P < 0.001). In the sub-analysis of serrated polyps, the visibility for the margin and surface on TXI + CE was also significantly better than that on WLI, TXI, and CE (P < 0.001).
CONCLUSION TXI + CE enhanced the visibility of the margin and surface compared to WLI, TXI, and CE for colorectal lesions.
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Affiliation(s)
- Takuma Hiramatsu
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
| | - Yosuke Kataoka
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Shuntaro Yoshida
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Tatsuya Matsuno
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Hiroya Mizutani
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hideki Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hirotoshi Ebinuma
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
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16
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Pattarajierapan S, Tipmanee P, Supasiri T, Wisedopas N, Khomvilai S. Texture and color enhancement imaging (TXI) plus endocuff vision versus TXI alone for colorectal adenoma detection: a randomized controlled trial. Surg Endosc 2023; 37:8340-8348. [PMID: 37697119 DOI: 10.1007/s00464-023-10396-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND AIMS Increasing the adenoma detection rate (ADR) helps reduce the risk of post-colonoscopy colorectal cancer. Texture and Color Enhancement Imaging (TXI) improves ADR by enhancing the brightness and contrast of endoscopic images. Endocuff Vision (ECV) is a mucosal exposure device that helps flatten the colonic folds. The benefit of combining TXI with ECV has not been studied previously. Thus, we aimed to compare the ADR between using TXI combined with ECV and TXI alone. METHODS We conducted a prospective randomized controlled trial recruiting patients aged ≥ 40 years who underwent colonoscopy for colorectal cancer screening or gastrointestinal symptoms. The participants were randomized in a 1:1 ratio into the TXI with ECV (TXI + ECV) and the TXI groups. Experienced endoscopists with ≥ 40% ADR performed all colonoscopies. The primary outcome was ADR. RESULTS We had 189 and 192 patients in the TXI + ECV and TXI groups, respectively. The baseline characteristics of both groups were comparable. The ADR was significantly higher in the TXI + ECV group than in the TXI group (65.6% vs. 52.1%, P = 0.007). Adenoma per colonoscopy (APC) was significantly greater in the TXI + ECV group than in the TXI group (1.6 vs. 1.2, P = 0.021), prominently proximal (1.0 vs. 0.7, P = 0.031), non-pedunculated (1.4 vs. 1.1, P = 0.035), and diminutive (1.3 vs. 1, P = 0.045) adenomas. Serrated lesion detection rate, insertion time, and withdrawal time did not differ between the groups. CONCLUSION Adding ECV to TXI significantly improves ADR and APC compared to using TXI alone. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20220507004.
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Affiliation(s)
- Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Phadungkiat Tipmanee
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Thanan Supasiri
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Naruemon Wisedopas
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Nagai M, Suzuki S, Minato Y, Ishibashi F, Mochida K, Ohata K, Morishita T. Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials. Clin Endosc 2023; 56:553-562. [PMID: 37491990 PMCID: PMC10565430 DOI: 10.5946/ce.2023.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 07/27/2023] Open
Abstract
Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.
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Affiliation(s)
- Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Yohei Minato
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
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