Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Surg Endosc. 2023 Nov;37(11):8340-8348. doi: 10.1007/s00464-023-10396-0. Epub 2023 Sep 11.
Increasing the adenoma detection rate (ADR) helps reduce the risk of post-colonoscopy colorectal cancer. Texture and Color Enhancement Imaging (TXI) improves ADR by enhancing the brightness and contrast of endoscopic images. Endocuff Vision (ECV) is a mucosal exposure device that helps flatten the colonic folds. The benefit of combining TXI with ECV has not been studied previously. Thus, we aimed to compare the ADR between using TXI combined with ECV and TXI alone.
We conducted a prospective randomized controlled trial recruiting patients aged ≥ 40 years who underwent colonoscopy for colorectal cancer screening or gastrointestinal symptoms. The participants were randomized in a 1:1 ratio into the TXI with ECV (TXI + ECV) and the TXI groups. Experienced endoscopists with ≥ 40% ADR performed all colonoscopies. The primary outcome was ADR.
We had 189 and 192 patients in the TXI + ECV and TXI groups, respectively. The baseline characteristics of both groups were comparable. The ADR was significantly higher in the TXI + ECV group than in the TXI group (65.6% vs. 52.1%, P = 0.007). Adenoma per colonoscopy (APC) was significantly greater in the TXI + ECV group than in the TXI group (1.6 vs. 1.2, P = 0.021), prominently proximal (1.0 vs. 0.7, P = 0.031), non-pedunculated (1.4 vs. 1.1, P = 0.035), and diminutive (1.3 vs. 1, P = 0.045) adenomas. Serrated lesion detection rate, insertion time, and withdrawal time did not differ between the groups.
Adding ECV to TXI significantly improves ADR and APC compared to using TXI alone.
Thai Clinical Trials Registry TCTR20220507004.
提高腺瘤检出率（ADR）有助于降低结直肠镜检查后的结直肠癌风险。纹理和颜色增强成像（TXI）通过增强内镜图像的亮度和对比度来提高 ADR。Endocuff Vision（ECV）是一种黏膜暴露装置，有助于使结肠褶皱变平。此前尚未研究过 TXI 与 ECV 联合应用的益处。因此，我们旨在比较 TXI 联合 ECV 与 TXI 单独使用的 ADR。
我们进行了一项前瞻性随机对照试验，招募年龄≥40 岁的因结直肠癌筛查或胃肠道症状而行结肠镜检查的患者。参与者以 1:1 的比例随机分为 TXI 联合 ECV（TXI+ECV）组和 TXI 组。具有≥40% ADR 的经验丰富的内镜医师进行所有结肠镜检查。主要结局是 ADR。
TXI+ECV 组和 TXI 组分别有 189 例和 192 例患者。两组的基线特征相当。TXI+ECV 组的 ADR 明显高于 TXI 组（65.6% vs. 52.1%，P=0.007）。TXI+ECV 组的腺瘤每例结肠镜（APC）明显大于 TXI 组（1.6 vs. 1.2，P=0.021），主要位于近端（1.0 vs. 0.7，P=0.031）、无蒂（1.4 vs. 1.1，P=0.035）和微小（1.3 vs. 1，P=0.045）腺瘤。锯齿状病变检出率、插入时间和退出时间在两组之间无差异。
与单独使用 TXI 相比，在 TXI 中加入 ECV 可显著提高 ADR 和 APC。
泰国临床试验注册中心 TCTR20220507004。
