S1259 Texture and Color Enhancement Imaging (TXI) vs High-Definition White Light Imaging (WLI) in the Detection of Precancerous Lesions: A Systematic Review and Meta-Analysis

Introduction: Early detection of tubular adenomas (TA) and sessile serrated lesions (SSLs) is crucial in the prevention of colorectal cancer. White light imaging (WLI) is one of the most used endoscopic modalities for the visualization of lesions in the colon. Recently, texture and color enhancement imaging (TXI), a new modality, was introduced. This systematic review and meta-analysis aims to evaluate the efficacy of TXI in comparison to WLI in the detection of adenomas and SSLs. Methods: This systematic review and meta-analysis followed PRISMA guidelines. A systematic search of PubMed/MEDLINE, Embase, and Google Scholar was conducted up to October 2024. Included studies were randomized controlled trials (RCTs) and observational studies involving adults (>18 years) undergoing colonoscopy for screening, surveillance, or diagnostic purposes. Studies focused on hereditary cancer syndromes or inflammatory bowel disease were excluded. Risk of bias was assessed using the Cochrane RoB 2.0 tool for RCTs and ROBINS-I for observational studies. A fixed-effect model was used for pooling adenoma-related outcomes, while a random-effects model was used for SSL detection. Results: Two RCTs including a total of 1,071 patients were analyzed for adenoma-related outcomes. The adenoma detection rate (ADR) was higher in the TXI group compared to the WLI group (RR: 1.37, 95% CI [1.21–1.54], P < 0.00001; I² = 0%). The mean number of adenomas per colonoscopy (APC) was also greater in the TXI group (Mean Difference: 0.68, 95% CI [0.55–0.80], P < 0.00001; I² = 79%). For SSL detection, 3 studies were included: 2 RCTs and 1 observational study. SSL detection was higher with TXI compared to WLI with RR of 1.45 (95% CI: 1.07-1.97, P = 0.02, I2 = 0%). All studies included in the analysis were found to have a low risk of bias. Conclusion: TXI was found to have improved detection rates of adenomas and SSLs when compared to WLI. The increased ADR, APC, and SSL detection rate highlights it as a promising advancement in colonoscopy which can potentially improve the early detection of colorectal lesions and prevent colorectal cancer.