Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2023; 15(12): 690-698
Published online Dec 16, 2023. doi: 10.4253/wjge.v15.i12.690
Improved visibility of colorectal tumor by texture and color enhancement imaging with indigo carmine
Takuma Hiramatsu, Toshihiro Nishizawa, Yosuke Kataoka, Shuntaro Yoshida, Tatsuya Matsuno, Hiroya Mizutani, Hideki Nakagawa, Hirotoshi Ebinuma, Mitsuhiro Fujishiro, Osamu Toyoshima
Takuma Hiramatsu, Hiroya Mizutani, Hideki Nakagawa, Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Toshihiro Nishizawa, Hirotoshi Ebinuma, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
Yosuke Kataoka, Shuntaro Yoshida, Tatsuya Matsuno, Osamu Toyoshima, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Author contributions: Hiramatsu T and Nishizawa T drafted the article; Hiramatsu T and Toyoshima O reviewed endoscopic images; Hiramatsu T edited endoscopic images; Nishizawa T contributed to the review of endoscopic and statistical analysis; Kataoka Y, Yoshida S, Matsuno T, Mizutani H, Nakagawa H, Ebinuma H, and Fujishiro M participated in the critical review and final manuscript approval; Toyoshima O involved in the conception of article, taking endoscopic images, review of endoscopic images, and final manuscript approval.
Institutional review board statement: Our study was approved by the ethics committee of the Certified Institutional Review Board of the Yoyogi Mental Clinic (certificate number. RKK227).
Informed consent statement: We published the study protocol on our clinic’s website (, allowing patients to opt out of the study if desired. Written consent to participate in the study was obtained before endoscopy.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Toshihiro Nishizawa, MD, PhD, Professor, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Hatakeda 852, Narita, Chiba, Narita 286-8520, Japan.
Received: September 21, 2023
Peer-review started: September 21, 2023
First decision: October 24, 2023
Revised: October 25, 2023
Accepted: November 24, 2023
Article in press: November 24, 2023
Published online: December 16, 2023
Processing time: 84 Days and 12.8 Hours
Research background

Texture and color enhancement imaging (TXI) was developed to provide higher visibility of colorectal lesions. Chromoendoscopy (CE) also improved the recognition of colorectal lesions.

Research motivation

There is no literature regarding visibility on the combination of TXI and CE for colorectal tumors.

Research objectives

This study assessed the effectiveness of TXI + CE for the treatment of colorectal adenomas and serrated polyps.

Research methods

Endoscopic images of adenomas or serrated polyps were obtained with white light imaging (WLI), TXI, CE, and TXI + CE modalities. Expert endoscopists evaluated the visibility scores of the margins and surface patterns. The visibility scores were given in four ranks.

Research results

The visibility of margins and surfaces of the colorectal lesions was in the order of TXI + CE, CE, TXI, and WLI, with TXI + CE being the best. In the sub-analysis of adenomas and serrated polyps, the visibility for the margins and surface on TXI + CE was significantly better than that on WLI, TXI, and CE alone (P < 0.001).

Research conclusions

Regarding the visibility of margins and surface of colorectal lesions, the combination of TXI + CE was better than that of WLI, TXI, and CE alone.

Research perspectives

A prospective randomised controlled trial is desired to confirm these findings.