Colonoscopy is the gold standard for colorectal cancer screening, but its effectiveness depends on factors like bowel preparation, technique, and strategies to improve detection. Enhancing visualization is key to reducing missed lesions. Texture and Color Enhancement Imaging (TXI) augments texture, brightness, and color which could potentially help identify adenomatous lesions. This meta-analysis evaluates the effectiveness of TXI on adenoma detection rate (ADR) and adenomas per colonoscopy (APC) compared to white light imaging (WLI).

A comprehensive literature search for randomized controlled trials (RCTs) comparing TXI to WLI in patients undergoing colonoscopy was done in PubMed, EMBASE, and Cochrane CENTRAL. Statistical analysis was conducted with RevMan using a random-effects model to compute the risk ratio and mean difference.

This meta-analysis included 3 RCTs. The TXI group comprised 989 patients while the WLI group had 978 patients. Analysis of the outcomes of interest showed a trend favoring TXI vs. WLI, with increased ADR (Risk Ratio: 1.22, 95% CI: 0.98-1.52) and increased APC (Mean Difference: 0.34, 95% CI: -0.13-0.81) with no statistical significance. However, there was significant heterogeneity for both outcomes.

This meta-analysis of RCTs suggests that TXI, compared to WLI, can improve ADR and APC. The heterogeneity may possibly be explained in the use of older generations of colonoscopes in the WLI arm in the RCTs of Antonelli and Young. In the RCT of Toyoshima, the same latest generation scope was used in both arms. Thus, we recommend that subsequent studies use the same latest generation scope for both arms.