Introduction

The efficacy of texture and color enhancement imaging (TXI) is a new observational mode in the novel light-emitting diode (LED) endoscopic system (EVIS-X1) for polyp detection. However, the efficacy of TXI has not been examined well.

Aims & Methods

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.

Results

The TXI and NBI groups consisted of 177 and 181 patients, respectively. Regarding the Add-30-s observation using TXI and NBI, the mean polyp sizes (mm) were 3.8±3.2 and 2.9±2.5, (p=0.04), the ratios of cecal location were 14.3% and 34.3% (p<0.01), and the ratios of polypoid morphology were 66.1% and 62.9% (p=0.49), respectively. The MAPs/MASPs/MAPPs were 0.23/0.29/0.32 and 0.24/0.30/0.35 in the TXI and NBI groups, respectively (p=0.83/0.87/0.59). Regarding MASP of TXI and NBI as the primary endpoint of this study, between-group difference of 1.0%, 95% CI -0·38 to 20·04), indicating non-inferiority (p<0.001). MAP and MAPP were also significantly non-inferior between the two groups. The increases in the ADR, ASDR, and PDR in the TXI/NBI groups were 10.2%/10.5% (p=0.81), 13.0%/12.7% (p=0.71), and 15.3%/13.8% (p=0.71), respectively. The MAPs in the first WLI observation and the first+second observation were 0.49 and 0.71 (p=0.02) in the TXI group (p=0.02) and 0.42 and 0.66 (p=0.01) in the NBI group, respectively. The MASPs in the first WLI observation and the first+second observation were 0.58 and 0.86 (p=0.02) in the TXI group and 0.46 and 0.76 (p<0.01) in the NBI group, respectively. There were no significant differences in the ADR, ASDR, and PDR between the first observation and the first+second observation in both the TXI and NBI groups.

Conclusion

Regarding add-30-s observation of the right-sided colon, TXI was non-inferior to NBI. Add-30-s observation with either NBI or TXI could increase the ADR by 10%.

References

no references

Introduction

Identification and subsequent removal of colorectal polyps has been demonstrated to deduce the mortality of colorectal cancer. However, approximately 25% of colorectal polyps can be missed under conventional endoscopic examination using white light imaging (WLI). Texture and color enhancement imaging (TXI) is a new modality developed to improve the detection of polyps, which enhancing the color tone and mucosal structure of lesions using an image color tone algorithm. We conducted a crossover prospective randomized observational study comparing the detection rate of colorectal polyps between WLI group and TXI group.

Aims & Methods

A total of 700 patients who underwent lower gastrointestinal endoscopy at Yokohama Sakae Kyosai Hospital between June 2022 and January 2023 were included in this study. After reaching the cecum, polyps were identified while the scope was withdrawn to the hepatic flexure in a randomly assigned observation mode. The scope was reinserted into the cecum and polyps were identified using the other observation mode. After evaluation of size and morphology of colorectal polyps, they were removed endoscopically and pathological evaluation was performed. Primary outcome was polyp detection rate. We also evaluated the characteristics of missed lesions. Additionally, multivariate logistic regression analysis was performed to reveal the factors affecting the polyp detection rate.

Results

Prevalence and number of lesions according to study group	TXI (n = 336)	WLI (n = 338)	P value
Detected polyps, n	226	210	0.48
First inspection
Patient with polyps, n (%)	126 (37.5%)	96 (28.4%)	0.014
Patient with adenomas, n (%)	107 (31.8%)	81 (24.9%)	0.026
The polyp miss rate	19.9%(45/226)	32.4%(68/210)	0.003
Subgroup analysis of missed lesions	Polyp miss rate(PMR)
Polyp size	TXI	WLI	P value
5-9mm	12.3% (8/65)	38.2% (29/76)	0.001

There were no significant differences in age, sex, bowel cleanliness, or cecum intubation rate between TXI and WLI groups. Except in cases of inadequate bowel preparation and discontinuation, 336 and 338 patients were included in TXI and WLI groups, respectively. Although the total number of polyps were not differed between TXI and WLI groups (226 vs 210, p=0.48), the polyp detection rate was significantly higher in TXI group (37.5% vs 28.4%, p=0.01). The adenoma detection rate was also higher in TXI group (31.8% vs 24.9%, p=0.03). Additionally, the polyp miss rate was significantly lower in the TXI group (19.9% vs 32.4%, p=0.003). No difference in polyp miss rate between the two groups for lesion sizes <5mm and 10mm>, but for lesions 5-9mm, the TXI group had a significantly lower polyp miss rate (12.3% vs 38.2%, p=0.001).
Multivariate logistic regression analysis revealed that TXI observation (OR 1.51, 95% CI 1.09-2.09, p=0.01) and older age (OR 1.71, 95% CI 1.18-2.48, p=0.004) were independent significant factors affection the colorectal polyp detection.

Conclusion

TXI may improve the identification of colorectal polyps, especially for small polyps.

References

Sakamoto T, Ikematsu H, Tamai N, Mizuguchi Y, Takamaru H, Murano T, Shinmura K, Sasabe M, Furuhashi H, Sumiyama K, Saito Y (2023) Detection of colorectal adenomas with Texture and Color Enhancement Imaging: multicenter observational study. Dig Endosc 35:529–537

Introduction

A new LED endoscopy system featuring advanced noise-reduction technology for enhanced brightness and minimal halation, the EP-8000 with the EC-860ZP colonoscope (Fujifilm), is scheduled to be released.

Aims & Methods

We conducted a multicenter, observational study to evaluate the new system’s potential improvements in image quality compared to a previous system/scope (VP-7000/EC-760ZP). From January 2024 to January 2025, patients undergoing colonoscopy at two institutions were enrolled. Images of the cecum and lesions were captured using white light imaging (WLI), blue light imaging (BLI), and linked color imaging (LCI) under similar conditions about air insufflation, angle, distance, and so on. Participants were divided into three groups: Group 1 (EP-8000+EC-860ZP; 50 cases), Group 2 (EP-8000+EC-760ZP; 50 cases), and Group 3 (VP-7000+EC-760ZP; 50 cases). Cecal images were evaluated for brightness and halation using a four-point scale (1=poor to 4=excellent) by endoscopists and original values by image-analysis software, while lesion images were assessed for brightness, halation, and visibility by endoscopists.

Results

In cecal images, the endoscopists’ scores for WLI in Group 1 were significantly better than in Group 3 for brightness (3.71±0.55 vs. 3.51±0.58, p<0.001) and for halation (3.60±0.51 vs. 3.18±0.59, p<0.001). Similarly, for BLI and LCI, Group 1 achieved higher scores than Group 3 regarding brightness (BLI: 3.15±0.85 vs. 2.23±0.92, p<0.001; LCI: 3.83±0.42 vs. 3.54±0.58, p<0.001) and halation (BLI: 2.99±0.69 vs. 2.71±0.78, p<0.001; LCI: 3.33±0.60 vs. 3.10±0.58, p<0.001). Software analysis confirmed that Group 1 had superior brightness values compared to Group 3 for WLI (122.7±6.6 vs. 110.7±7.7, p<0.001), BLI (99.1±10.9 vs. 69.3±11.5, p<0.001), and LCI (139.4±9.2 vs. 113.1±10.7, p<0.001), as well as lower halation values for WLI (1.34±1.80 vs. 3.35±3.59, p=0.031) and LCI (1.48±0.83 vs. 4.06±3.99, p=0.010). Regarding lesion images, brightness, halation, and visibility for WLI, BLI, and LCI were significantly better in Group 1 than in Group 3.

Conclusion

The new LED system provided marked improvements in brightness, halation, and lesion visibility. The software assessment was consistent with endoscopists assessment objective and can be used for the development and evaluation of new endoscopic systems.

References

Nishizawa T, Toyoshima O, Yoshida S, et al. TXI (Texture and Color Enhancement Imaging) for Serrated Colorectal Lesions. J Clin Med 2021; 11: 119.
Okumura T, Hotta K, Imai K, et al. Efficacy of texture and color enhancement imaging for the visibility and diagnostic accuracy of non-polypoid colorectal lesions. DEN Open 2024; 29; 5: e380.
Antonelli G, Bevivino G, Pecere S, et al. Texture and color enhancement imaging versus high definition white-light endoscopy for detection of colorectal neoplasia: a randomized trial. Endoscopy 2023; 55 :1072-1080.
Yoshida N, Inagaki Y, Inada Y, et al. Additional 30-Second Observation of the Right-Sided Colon for Missed Polyp Detection With Texture and Color Enhancement Imaging Compared with Narrow Band Imaging: A Randomized Trial. Am J Gastroenterol 2024; 119: 539-546.
Aniwan S, Vanduangden K, Kerr SJ, et al. Linked color imaging, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized trial. Gastrointest Endosc 2021; 94: 969-977.
Yoshida N, Draganov PV, John S, et al. Comparison of LED and LASER Colonoscopy About Linked Color Imaging and Blue Laser/Light Imaging of Colorectal Tumors in a Multinational Study. Dig Dis Sci 2023; 68: 3943-3952.

Disclosure

Yoshida N and Dohi O received a research grant from Fujifilm Co. Yamamoto H had a consultant relationship with Fujifilm Co. and received honoraria, grants, and royalties from the company. Yano T received a research grant and honoraria from Fujifilm, Japan. The other authors declare no conflicts of interest. Novel endoscopic systems and scopes were lent by Fujifilm Co.

Introduction

Improving the adenoma detection rate (ADR) can contribute to reducing the incidence and mortality of post-colonoscopy colorectal cancer (PCCRC). Texture and color enhancement imaging (TXI) enhances subtle tissue textures, selectively brightens dark areas, and emphasizes the differences between red and white colors^1,2. Several studies have investigated the visibility and color differences of TXI in vitro and reported its superiority over WLI^3-7. However, A few studies have evaluated the ADR of colonoscopy with TXI, which is a novel image-enhancing technology. This study aims to compare the detection of colorectal polyps using TXI to that using white light imaging (WLI).

Aims & Methods

This study was conducted retrospectively in a single center using propensity-matched scoring based on the patients’ baseline characteristics, such as age, sex, indication, bowel preparation, endoscopist, colonoscope type, and withdrawal time. This study compared the effectiveness of WLI and TXI in patients who underwent chromocolonoscopy with indigo carmine spraying. The study determined the differences in the adenoma, including high-risk adenoma, and sessile serrated lesion (SSL) detection rates and the mean number of detected adenomas and SSLs per colonoscopy between the TXI and WLI groups. High-risk adenomas were defined as three or more adenomas, an adenoma ≥10 mm, an adenoma with a villous component, and an adenoma with high-grade dysplasia. The Wald test with logistic regression was used to analyze the P values.

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 0-II morphology according to the Paris classification (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. The adenoma plus SSL detection rate (ASDR) was higher in the TXI group than in the WLI group (58.8% vs. 53.2%, OR: 1.25). The mean number of adenomas plus SSLs per colonoscopy (ASPC) was greater in the TXI group than in the WLI group (1.287 vs. 1.025, OR: 1.13, Table).

Table. Polyp detection using TXI compared with WLI.
	WLI	TXI	Odds ratio	95% CI	P value
ADR, %	49.4	55.0	1.25	1.10-1.42	<0.001
High-risk ADR, %	12.8	17.6	1.45	1.22-1.73	<0.001
APC, n	0.94	1.19	1.12	1.07-1.17	<0.001
APC, 0-II type, n	0.85	1.09	1.14	1.09-1.19	<0.001
APC, <6 mm, n	0.76	0.99	1.16	1.10-1.22	<0.001
ASDR, %	53.2	58.8	1.25	1.11-1.42	<0.001
ASPC, n	1.03	1.287	1.13	1.08-1.18	<0.001

Conclusion

A randomized controlled trial⁸ and a cross-over study⁹ previously showed that the ADR of TXI was higher than that of WLI. In this study, we found that the ADR, high-risk ADR, APC, ASDR, and ASPC of TXI were higher than those of WLI after propensity-score matching of patients who underwent chromoendoscopy. TXI may help prevent PCCRC.

References

1 Sato T. TXI: Texture and Color Enhancement Imaging for Endoscopic Image Enhancement. J Healthc Eng 2021; 2021.
2 Tani Y, et al. Gastrointestinal: Texture and color enhancement imaging is useful for detection of small gastric adenocarcinoma of fundic-gland type. J Gastroenterol Hepatol 2024.
3 Nishizawa T, et al. TXI (Texture and Color Enhancement Imaging) for Serrated Colorectal Lesions. J Clin Med 2021.
4 Toyoshima O, et al. Texture and color enhancement imaging in magnifying endoscopic evaluation of colorectal adenomas. World J Gastrointest Endosc 2022.
5 Tamai N, et al. Visibility evaluation of colorectal lesion using texture and color enhancement imaging with video. DEN Open 2022.
6 Yoshida N, et al. Analysis of Texture and Color Enhancement Imaging for Improving the Visibility of Non-polypoid Colorectal Lesions. Dig Dis Sci 2022.
7 Hiramatsu T, et al. Improved visibility of colorectal tumor by texture and color enhancement imaging with indigo carmine. World J Gastrointest Endosc 2023.
8. Antonelli G, et al. Texture and color enhancement imaging versus high definition white-light endoscopy for detection of colorectal neoplasia: a randomized trial. Endoscopy 2023.
9. Sakamoto T, et al. Detection of colorectal adenomas with texture and color enhancement imaging: Multicenter observational study. Dig Endosc 2023.

Disclosure

​Nothing