Efficacy of Texture and Color Enhancement Imaging for Identification of Colorectal Polyps: A Prospective Crossover Randomized Trial

Objective To reveal the efficacy of texture and color enhancement imaging (TXI), which highlights changes in the brightness, color, and texture of colorectal polyps, we conducted a prospective crossover randomized trial. Methods Between June 2022 and January 2023, 700 consecutive patients who underwent colonoscopy were randomly assigned (1:1) to the TXI or white‐light imaging (WLI) groups. After the first inspection of the right colon, the endoscope was reinserted into the cecum, and a second inspection was performed using another mode. The outcomes measured were polyp detection rate (PDR), adenoma detection rate (ADR), serrated lesion detection rate (SDR), and mean number of lesions per colonoscopy. Missed lesion analyses were also performed. Results Although the PDR and ADR were significantly higher in the TXI group (37.5% vs. 28.4%, p = 0.01; and 31.8% vs. 24.9%, p = 0.03, respectively), the SDR did not differ between the two groups (8.6% vs. 6.5%, p = 0.24). More polyps were identified in the TXI group than in the WLI group at the first inspection (0.54 vs. 0.42, p = 0.01). The polyp miss rate was significantly lower in the TXI group than in the WLI group (19.9% vs. 32.4%, p = 0.003). Although small polyps (< 5 mm) tended to be missed in both groups, the miss rate of moderate‐sized polyps (5–9 mm) was significantly lower in the TXI group (12.3% vs. 38.2%, p = 0.001). Conclusions Compared to WLI, TXI exhibited a higher PDR and ADR in the right colon.