The efficacy of texture and color enhancement imaging (TXI) observation in the detection of colorectal lesions: a multicenter, randomized controlled trial (deTXIon study)

Abstract

Background and 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 eight Japanese institutions between March 2023 and October 2023. Participants aged 40-80 years old scheduled for CRC screening and non-screening purposes, such as post-polypectomy 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 endpoint was the mean number of adenomas detected per procedure (MAP). Secondary endpoints included the adenoma detection rate (ADR), polyp detection rate (PDR), flat polyp detection rate (FDR), and adverse events.

Results

956 patients were enrolled and randomized. After excluding patients who did not meet the eligibility criteria, 451 and 445 patients were included in the TXI and WLI arms, respectively. The MAP and ADR were 1.4 and 1.5, and 57.2% and 56.0% in TXI and WLI, respectively, and there were no statistically significant differences between two arms. PDR and FDR were significantly higher in TXI than in WLI, which were 82.5% vs. 74.4%, P=0.003, and 76.5% vs. 70.3%, P=0.036, 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.