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Texture and color enhancement imaging (TXI) plus endocuff vision versus TXI alone for colorectal adenoma detection: a randomized controlled trial

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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.

Graphical abstract

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Acknowledgements

The authors would like to thank the nursing team of our endoscopy unit for their support in conducting this study.

Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand

    Sukit Pattarajierapan, Phadungkiat Tipmanee & Supakij Khomvilai

  2. King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

    Sukit Pattarajierapan

  3. Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Thanan Supasiri

  4. Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Naruemon Wisedopas

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  1. Sukit Pattarajierapan
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Contributions

Study concept and performance were developed and organized by SP, PT, TS, NW, and SK. Endoscopists who performed colonoscopies and provided the data were SP and SK. Pathologic examinations were performed by NW. Essential data monitoring and statistical analysis were performed by PT and TS. Paper writing was done by SP, TS, and SK. All authors had access to the data and reviewed and approved the final manuscript.

Corresponding author

Correspondence to Supakij Khomvilai.

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Disclosures

Sukit Pattarajierapan, Phadungkiat Tipmanee, Thanan Supasiri, and Supakij Khomvilai have no conflict of interest or financial ties to disclose.

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Pattarajierapan, S., Tipmanee, P., Supasiri, T. et al. Texture and color enhancement imaging (TXI) plus endocuff vision versus TXI alone for colorectal adenoma detection: a randomized controlled trial. Surg Endosc 37, 8340–8348 (2023). https://doi.org/10.1007/s00464-023-10396-0

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