Efficacy of image-enhanced endoscopy for colorectal adenoma detection: A multicenter, randomized trial.

Background: Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer. However, whether image-enhanced endoscopy (IEE) further improves the adenoma detection rate (ADR) is controversial.

Aim: To compare IEE with white-light imaging (WLI) endoscopy for the detection and identification of colorectal adenoma.

Methods: This was a multicenter, randomized, controlled trial. Participants were enrolled between September 2019 to April 2021 from 4 hospital in China. Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal ( = 2113) or a WLI group with WLI on both entry and withdrawal ( = 2098). The primary outcome was the ADR. The secondary endpoints were the polyp detection rate (PDR), adenomas per colonoscopy, adenomas per positive colonoscopy, and factors related to adenoma detection.

Results: A total of 4211 patients (966 adenomas) were included in the analysis (mean age, 56.7 years, 47.1% male). There were 2113 patients (508 adenomas) in the IEE group and 2098 patients (458 adenomas) in the WLI group. The ADR in two group were not significantly different [24.0% 21.8%, 1.10, 95% confidence interval (CI): 0.99-1.23, = 0.09]. The PDR was higher with IEE group (41.7%) than with WLI group (36.1%, 1.16, 95%CI: 1.07-1.25, = 0.01). Differences in mean withdrawal time (7.90 ± 3.42 min 7.85 ± 3.47 min, = 0.30) and adenomas per colonoscopy (0.33 ± 0.68 0.28 ± 0.62, = 0.06) were not significant. Subgroup analysis found that with narrow-band imaging (NBI), between-group differences in the ADR, were not significant (23.7% 21.8%, 1.09, 95%CI: 0.97-1.22, = 0.15), but were greater with linked color imaging (30.9% 21.8%, 1.42, 95%CI: 1.04-1.93, = 0.04). the second-generation NBI (2G-NBI) had an advantage of ADR than both WLI and the first-generation NBI (27.0% 21.8%, = 0.01; 27.0% 21.2.0%, = 0.01).

Conclusion: This prospective study confirmed that, among Chinese, IEE didn't increase the ADR compared with WLI, but 2G-NBI increase the ADR.