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

Zhi-Peng Qi; En-Pan Xu; Dong-Li He; Yan Wang; Bai-Sheng Chen; Xue-Si Dong; Qiang Shi; Shi-Lun Cai; Qi Guo; Ni Li; Xing Li; Hai-Yan Huang; Bing Li; Di Sun; Jian-Guang Xu; Zhang-Han Chen; Ayimukedisi Yalikong; Jin-Yi Liu; Zhen-Tao Lv; Jian-Min Xu; Ping-Hong Zhou; Yun-Shi Zhong

doi:10.4251/wjgo.v15.i5.878

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

World J Gastrointest Oncol. 2023 May 15;15(5):878-891. doi: 10.4251/wjgo.v15.i5.878.

Authors

Zhi-Peng Qi¹, En-Pan Xu¹, Dong-Li He², Yan Wang³, Bai-Sheng Chen⁴, Xue-Si Dong⁵, Qiang Shi¹, Shi-Lun Cai¹, Qi Guo², Ni Li⁵, Xing Li⁶, Hai-Yan Huang⁷, Bing Li¹, Di Sun¹, Jian-Guang Xu⁸, Zhang-Han Chen¹, Ayimukedisi Yalikong¹, Jin-Yi Liu¹, Zhen-Tao Lv¹, Jian-Min Xu⁹, Ping-Hong Zhou¹, Yun-Shi Zhong¹⁰

Affiliations

¹ Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China.
² Endoscopy Center, Shanghai Xuhui Central Hospital, Shanghai 200030, China.
³ Endoscopy Center, Traditional Chinese Medical Hospital, Rongcheng 264300, Shandong Province, China.
⁴ Department of Endoscopy Center, Xiamen Branch of Affiliated Zhongshan Hospital of Fudan University, Xiamen 361000, Fujian Province, China.
⁵ Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China.
⁶ Department of Gastroenterology, Pingxiang People's Hospital, Pingxiang 337000, Jiangxi Province, China.
⁷ Department of Clinical Medicine, Xiaogang Hospital, Ningbo 315000, Zhejiang Province, China.
⁸ Endoscopy Center, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China.
⁹ Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai 200030, China.
¹⁰ Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China. zhong.yunshi@zs-hospital.sh.cn.

Abstract

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 (n = 2113) or a WLI group with WLI on both entry and withdrawal (n = 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% vs 21.8%, 1.10, 95% confidence interval (CI): 0.99-1.23, P = 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, P = 0.01). Differences in mean withdrawal time (7.90 ± 3.42 min vs 7.85 ± 3.47 min, P = 0.30) and adenomas per colonoscopy (0.33 ± 0.68 vs 0.28 ± 0.62, P = 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% vs 21.8%, 1.09, 95%CI: 0.97-1.22, P = 0.15), but were greater with linked color imaging (30.9% vs 21.8%, 1.42, 95%CI: 1.04-1.93, P = 0.04). the second-generation NBI (2G-NBI) had an advantage of ADR than both WLI and the first-generation NBI (27.0% vs 21.8%, P = 0.01; 27.0% vs 21.2.0%, P = 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.

Keywords: Adenoma detection rate; Endoscopy; Image-enhanced endoscopy; Narrow-band imaging; White-light imaging.