Texture and Color Enhanced Imaging in the Diagnosis of Colonic Neoplasia: A Systematic Review and Analysis.

Introduction: Image enhanced endoscopy (IEE) can augment the detection of colorectal cancer (CRC) and its precursor lesions, potentially reducing incidence and mortality. Early data on texture and color enhancement imaging (TXI) support its use for neoplasia screening. This study aimed to systematically review and perform a meta-analysis to assess the impact of TXI on colonic adenoma detection.

Methods: The systematic review and meta-analysis followed PRISMA guidelines. Studies comparing TXI with white light imaging (WLI) were eligible for inclusion. Searches were conducted through relevant databases and major conferences up to July 1, 2024. The primary outcome was ADR, with secondary outcomes including polyp detection rate (PDR), mean number of adenomas per patient (MAP), and size, location, morphology, and withdrawal time.

Results: From 1270 results, 4 studies were included in the meta-analysis ( = 5481). TXI significantly increased ADR compared to WLI (55.8% vs. 47.8%, RR 1.24,  < 0.001), PDR (63.7% vs. 54.7%, RR 1.23,  < 0.001), and MAP (mean difference 0.41,  = 0.005). and improved detection of proximal lesions (MD 0.21, 95% CI [0.15-0.27],  < 0.001,  = 0%). Pooled withdrawal times were not different between groups, with no differences between endoscopist experience or quality of bowel preparation, where reported. Sub-analysis further demonstrated superiority of TXI, with an absolute difference in ADR of 14.2%.

Conclusion: TXI significantly improves ADR, PDR, and MAP compared to WLI, highlighting its potential to enhance CRC screening efficacy without impact from user experience, bowel prep, or withdrawal times. TXI is a useful and practical adjunct to enhance the detection of colonic neoplasia.