Texture and color enhancement imaging (TXI) for polyp detection in colorectal neoplasia screening: A meta-analysis of randomized controlled trials.

Abstract

10582 Background: Colonoscopy remains the gold standard for preventing colorectal cancer; however, variable adenoma detection rates (ADR) among endoscopists highlight the need for improved visualization technologies. Texture and Color Enhancement Imaging (TXI) is a novel image-enhanced endoscopy modality designed to optimize the visibility of mucosal lesions by enhancing surface texture and brightness. This meta-analysis evaluates the efficacy of TXI compared to standard high-definition white-light imaging (HD-WLI) in the detection of colorectal neoplasia, specifically assessing whether enhanced visualization translates to higher detection rates of adenomas and polyps in a randomized controlled setting. Methods: We conducted a systematic review and meta-analysis of prospective randomized controlled trials (RCTs) published between 2023 and 2025. The analysis included adult patients undergoing colonoscopy for screening, surveillance, or diagnostic indications where TXI was compared to HD-WLI during the withdrawal phase. Primary outcomes included ADR, polyp detection rate (PDR), and adenomas per colonoscopy (APC). Secondary outcomes included polyps per colonoscopy (PPC) and flat lesion detection. Statistical analysis was performed using a random-effects model (DerSimonian-Laird method). Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated, with heterogeneity assessed via I² statistics. Results: The analysis pooled data from four RCTs comprising 2,308 patients. The chief finding was a statistically significant 25.5% increase in the Polyp Detection Rate (PDR) with TXI compared to WLI (pooled RR = 1.255; 95% CI: 1.050–1.498; p < 0.05). Regarding the Adenoma Detection Rate (ADR), TXI showed a positive trend with a 22% relative increase (pooled RR = 1.220; 95% CI: 0.981–1.519); however, this did not reach statistical significance (p > 0.05). Analysis of Adenomas per Colonoscopy (APC) showed no significant difference (MD = 0.153; p > 0.05). Substantial heterogeneity was observed across outcomes (I² > 60%), suggesting variability in endoscopist experience or study populations. Conclusions: Texture and Color Enhancement Imaging demonstrates clear superiority over white-light imaging for overall polyp detection, establishing it as a promising tool for identifying colorectal neoplasia. While TXI significantly improved PDR, the improvement in ADR showed a strong positive trend that did not reach statistical significance, likely due to high between-study heterogeneity. These findings suggest that TXI enhances lesion visibility, particularly for general polyps, but further large-scale RCTs are necessary to definitively establish its impact on adenoma detection and long-term interval cancer prevention.