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

doi:10.4251/wjgo.v15.i5.878

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World Journal of Gastrointestinal Oncology

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Randomized Controlled Trial

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

Table 1 Baseline characteristics

	IEE group (n = 2113)	WLI group (n = 2098)
Age (yr)	56.7 ± 12.9	56.8 ± 13.0
Male gender	1002 (47.7)	982 (46.8)
BMI (kg/m²)	23.4 ± 3.2	23.5 ± 3.2
Comorbidities
ASA1	1468 (69.5)	1510 (72.0)
ASA2	640 (30.3)	580 (27.6)
ASA3	5 (0.2)	8 (0.4)
Colorectal surgery history	149 (7.1)	134 (6.4)
Colonoscopy indication
Diagnostic	880 (41.6)	876 (41.8)
Surveillance	613 (29.0)	601 (28.6)
Screening	620 (29.3)	621 (29.6)
Colonoscopy history	892 (42.2)	879 (41.9)

Dates are n or n (%). IEE: Image-enhanced endoscopy; WLI: White-light imaging endoscopy; BMI: Body mass index.

Table 2 Overall adenoma detection rate in patients of the two group

	IEE group (n = 2113)	WLI group (n = 2098)	P value	Relative risk (95%CI)
ADR	508/2113 (24.0)	458/2098 (21.8)	0.09	1.10 (0.99-1.23)
Advanced ADR	127/2113 (6.0)	116/2098 (5.5)	0.50	1.09 (0.85-1.39)
Diminutive ADR	323/2113 (15.3)	286/2098 (13.6)	0.13	1.12 (0.97-1.30)
ADR in different ages
< 50 yr	67/586 (11.4)	54/557 (9.7)	0.34	1.18 (0.84-1.66)
≥ 50 yr	441/1527 (28.9)	404/1541 (26.2)	0.10	1.10 (0.98-1.24)
ADR in different gender
Male	288/1002 (28.7)	254/982 (25.9)	0.15	1.11 (0.96-1.28)
Female	220/1111 (19.8)	204/1116 (18.3)	0.36	1.08 (0.91-1.29)
ADR with different indications
Diagnostic
< 50 yr	26/270 (9.6)	23/256 (9.0)	0.80	1.07 (0.63-1.83)
≥ 50 yr	179/610 (29.3)	166/620 (26.8)	0.32	1.10 (0.92-1.31)
Surveillance
< 50 yr	9/104 (8.7)	7/93 (7.5)	0.77	1.15 (0.45-2.97)
≥ 50 yr	138/509 (27.1)	126/508 (24.8)	0.40	1.09 (0.89-1.5)
Screening
< 50 yr	32/212 (15.1)	24/208 (11.5)	0.28	1.31 (0.80-2.14)
≥ 50 yr	124/408 (30.4)	112/413 (27.1)	0.30	1.12 (0.90-1.39)
Withdrawal time	7.90 ± 3.42	7.85 ± 3.47	0.30

Dates are n or n (%). ADR: Adenoma detection rate; IEE: Image-enhanced endoscopy; WLI: White light imaging; CI: Confidence interval.

Table 3 All polyps analysis of both group

	IEE group (n = 2113)	WLI group (n = 2098)	P value	Relative risk (95%CI)
PDR	882/2113 (41.7)	757/2098 (36.1)	0.01	1.16 (1.07-1.25)
All polyps	1588	1319
Inflammatory polyp	426 (26.8)	341 (25.9)	0.55	1.04 (0.92-1.17)
Hyperplastic polyp	179 (11.3)	150 (11.4)	0.93	0.99 (0.81-1.22)
Adenoma polyp	690 (43.5)	590 (44.7)	0.49	0.97 (0.90-1.06)
Sessile serrated adenoma	10 (0.6)	11 (0.8)	0.52	0.76 (0.32-1.77)
Chronic inflammation	262 (16.5)	211 (16.0)	0.71	1.03 (0.87-1.22)
Cancer	16 (1.0)	13 (1.0)	0.95	1.02 (0.49-2.12)
Others	5 (0.3)	3 (0.2)	0.74¹	1.38 (0.33-5.78)
Adenoma per colonoscopy	0.33 ± 0.68	0.28 ± 0.62	0.06
Adenoma polyp	690	590
Size			0.44
≤ 5 mm	338 (49.0)	294 (49.8)		0.98 (0.88-1.10)
6-9 mm	211 (30.6)	163 (27.6)		1.11 (0.93-1.32)
≥ 10 mm	141 (20.4)	133 (22.5)		0.91 (0.74-1.12)
Shape			0.39
Pedunculated	72 (10.4)	76 (12.9)		0.81 (0.60-1.10)
Subpedunculated	186 (27.0)	154 (26.1)		1.03 (0.86-1.24)
Flat	432 (62.6)	360 (61.0)		1.03 (0.94-1.12)
Pathology			0.80
Tubular adenoma	670 (97.1)	569 (96.4)		1.01 (0.99-1.03)
Tubulovillous adenoma	18 (2.6)	19 (3.2)		0.81 (0.43-1.53)
Villous adenoma	2 (0.3)	2 (0.3)		0.86 (0.12-6.05)
Site			0.50
Left	258 (37.4)	236 (40.0)		0.94 (0.81-1.07)
Right	357 (51.7)	299 (50.7)		1.02 (0.92-1.14)
Rectum	75 (10.9)	55 (9.3)		1.17 (0.84-1.62)

¹Using fisher exact test.

Others in image-enhanced endoscopy group: Dermatofibroma × 1, fibroepithelial polyp × 1, neuroendocrine tumor × 1, soft fibroma × 1, gland hyperplasia × 1. Others in white light imaging group: Neuroendocrine tumor × 1, lymphoid polyps × 1, inflammatory granulation tissue × 1. Dates are n or n (%). PDR: Polyp detection rate; IEE: Image-enhanced endoscopy; WLI: White light imaging; CI: Confidence interval.

Table 4 Overall adenoma detection rate in patients of the subgroup

	NBI group (n = 2016)	LCI group (n = 97)	WLI group (n = 2098)	P value¹	RR (95%CI)	P value²	RR (95%CI)	P value³	RR (95%CI)
ADR	478/2016 (23.7)	30/97 (30.9)	458/2098 (21.8)	0.15	1.09 (0.97-1.22)	0.04	1.42 (1.04-1.93)	0.10	0.77 (0.56-1.04)
Advanced ADR	122/2016 (6.1)	5/97 (5.2)	116/2098 (5.5)	0.47	1.10 (0.86-1.40)	0.87	0.93 (0.39-2.23)	0.72	1.17 (0.49-2.80)
Diminutive ADR	304/2016 (15.1)	19/97 (19.6)	286/2098 (13.6)	0.19	1.11 (0.95-1.28)	0.10	1.44 (0.95-2.18)	0.23	0.77 (0.51-1.17)
ADR in different ages
< 50 yr	55/538 (10.2)	12/48 (25.0)	54/557 (9.7)	0.77	1.05 (0.74-1.51)	0.01	2.58 (1.49-4.48)	0.01	0.41 (0.24-0.71)
≥ 50 yr	423/1478 (28.6)	18/49 (36.7)	404/1541 (26.2)	0.14	1.09 (0.97-1.23)	0.10	1.40 (0.96-2.04)	0.22	0.78 (0.54-1.14)
ADR in different gender
Male	270/953 (28.3)	18/49 (36.7)	254/982 (25.9)	0.22	1.10 (0.95-1.27)	0.09	1.42 (0.97-2.08)	0.21	0.77 (0.53-1.13)
Female	208/1063 (19.6)	12/48 (25.0)	204/1116 (18.3)	0.44	1.07 (0.90-1.27)	0.24	1.37 (0.83-2.27)	0.36	0.78 (0.47-1.30)
ADR with different indications
Diagnostic
< 50 yr	23/247 (9.3)	3/23 (13.0)	23/256 (9.0)	0.90	1.04 (0.60-1.80)	0.46⁴	1.45 (0.47-4.47)	0.47⁴	0.71 (0.23-2.20)
≥ 50 yr	171/590 (29.0)	8/20 (40.0)	166/620 (26.8)	0.39	1.08 (0.90-1.30)	0.19	1.49 (0.86-2.60)	0.29	0.73 (0.42-1.26)
Surveillance
< 50 yr	8/96 (8.3)	1/8 (12.5)	7/93 (7.5)	0.84	1.11 (0.42-2.93)	0.50⁴	1.66 (0.23-11.87)	0.53⁴	0.67 (0.10-4.69)
≥ 50 yr	134/496 (27.0)	4/13 (30.8)	126/508 (24.8)	0.42	1.09 (0.88-1.34)	0.75⁴	1.24 (0.54-2.84)	0.76⁴	0.88 (0.38-2.01)
Screening
< 50 yr	24/195 (12.3)	8/17 (47.1)	24/208 (11.5)	0.81	1.07 (0.63-1.81)	0.01	4.08 (2.17-7.65)	0.01⁴	0.26 (0.14-0.49)
≥ 50 yr	118/392 (30.1)	6/16 (37.5)	112/413 (27.1)	0.35	1.11 (0.89-1.38)	0.40	1.38 (0.72-2.65)	0.58	0.80 (0.42-1.54)
Withdrawal time	7.90 ± 3.46	7.82 ± 2.67	7.85 ± 3.47	0.47		0.02		0.05

¹The P value between narrow band imaging group and white light imaging group.

²The P value between linked color imaging group and white light imaging group.

³The P value between narrow band imaging group and linked color imaging group.

⁴Using fisher exact test.

Dates are n or n (%). ADR: Adenoma detection rate; RR: Relative risk; NBI: Narrow band imaging; WLI: White light imaging; LCI: Linked color imaging; CI: Confidence interval.

Table 5 Subgroup analysis of all polyps

	NBI group (n = 2016)	LCI group (n = 97)	WLI group (n = 2098)	P value¹	RR (95%CI)	P value²	RR (95%CI)	P value³	RR (95%CI)
PDR	839/2016 (41.6)	43/97 (44.3)	757/2098 (36.1)	0.01	1.15 (1.07-1.25)	0.10	1.23 (0.98-1.55)	0.60	0.94 (0.75-1.18)
All polyps	1519	69	1319
Inflammatory polyp	421 (27.7)	5 (7.2)	341 (25.9)	0.26	1.07 (0.95-1.21)	0.01	0.28 (0.12-0.66)	0.01	3.83 (1.64-8.93)
Hyperplastic polyp	164 (10.8)	15 (21.7)	150 (11.4)	0.63	0.95 (0.77-1.17)	0.01	1.91 (1.19-3.07)	0.01	0.50 (0.31-0.80)
Adenoma polyp	647 (42.6)	43 (62.3)	590 (44.7)	0.25	0.95 (0.88-1.04)	0.01	1.39 (1.15-1.69)	0.01	0.68 (0.56-0.83)
Sessile serrated adenoma	10 (0.7)	0 (0)	11 (0.8)	0.59	0.79 (0.34-1.85)	1.00⁴		1.00⁴
Chronic inflammation	259 (17.1)	3 (4.3)	211 (16.0)	0.45	1.07 (0.90-1.26)	0.01	0.27 (0.09-0.83)	0.01	3.92 (1.29-11.93)
Cancer	13 (0.9)	3 (4.3)	13 (1.0)	0.72	0.87 (0.40-1.87)	0.04⁴	4.41 (1.29-15.12)	0.03⁴	0.20 (0.06-0.68)
Others	5 (0.3)	0 (0)	3 (0.2)	0.73⁴	1.45 (0.35-6.04)	1.00⁴		1.00⁴
Adenoma per colonoscopy	0.32 ± 0.67	0.44 ± 0.87	0.28 ± 0.62	0.11		0.03		0.10
Adenoma polyp	647	43	590
Size				0.56		0.22		0.33
≤ 5 mm	315 (48.7)	23 (53.5)	294 (49.8)		0.98 (0.87-1.09)		1.07 (0.80-1.44)		0.91 (0.68-1.22)
6-9 mm	196 (30.3)	15 (34.9)	163 (27.6)		1.10 (0.92-1.31)		1.26 (0.82-1.94)		0.87 (0.57-1.33)
≥ 10 mm	136 (21.0)	5 (11.6)	133 (22.5)		0.93 (0.76-1.15)		0.52 (0.22-1.19)		1.81 (0.78-4.18)
Shape				0.43		0.79		1.00⁴
Pedunculated	68 (10.5)	4 (9.3)	76 (12.9)		0.82 (0.60-1.11)		0.72 (0.28-1.88)		1.13 (0.43-2.95)
Subpedunculated	174 (26.9)	12 (27.9)	154 (26.1)		1.03 (0.86-1.24)		1.07 (0.65-1.76)		0.96 (0.59-1.58)
Flat	405 (62.6)	27 (62.8)	360 (61.0)		1.03 (0.94-1.12)		1.03 (0.81-1.31)		1.00 (0.79-1.26)
Pathology				0.90		0.68⁴		0.67
Tubular adenoma	627 (96.9)	43 (100)	569 (96.4)		1.01 (0.98-1.03)
Tubulovillous adenoma	18 (2.8)	0 (0)	19 (3.2)		0.86 (0.46-1.63)
Villous adenoma	2 (0.3)	0 (0)	2 (0.3)		0.91 (0.13-6.45)
Site				0.57		0.29⁴		0.31
Left	246 (38.0)	12 (27.9)	236 (40.0)		0.95 (0.83-1.09)		0.70 (0.43-1.14		1.36 (0.83-2.23)
Right	330 (51.0)	27 (62.8)	299 (50.7)		1.01 (0.90-1.12)		1.24 (0.97-1.58)		0.81 (0.64-1.04)
Rectum	71 (11.0)	4 (9.3)	55 (9.3)		1.18 (0.84-1.64)		1.00 (0.38-2.62)		1.18 (0.45-3.08)

¹The P value between narrow band imaging group and white light imaging group.

²The P value between linked color imaging group and white light imaging group.

³The P value between narrow band imaging group and linked color imaging group.

⁴Using fisher exact test.

Dates are n or n (%). Others in narrow band imaging group: Dermatofibroma × 1, fibroepithelial polyp × 1, neuroendocrine tumor × 1, soft fibroma × 1, gland hyperplasia × 1. Others in white light imaging group: Neuroendocrine tumor × 1, lymphoid polyps × 1, inflammatory granulation tissue × 1. PDR: Polyp detection rate; RR: Relative risk; NBI: Narrow band imaging; WLI: White light imaging; LCI: Linked color imaging; CI: Confidence interval.

Citation: Qi ZP, Xu EP, He DL, Wang Y, Chen BS, Dong XS, Shi Q, Cai SL, Guo Q, Li N, Li X, Huang HY, Li B, Sun D, Xu JG, Chen ZH, Yalikong A, Liu JY, Lv ZT, Xu JM, Zhou PH, Zhong YS. Efficacy of image-enhanced endoscopy for colorectal adenoma detection: A multicenter, randomized trial. World J Gastrointest Oncol 2023; 15(5): 878-891
URL: https://www.wjgnet.com/1948-5204/full/v15/i5/878.htm
DOI: https://dx.doi.org/10.4251/wjgo.v15.i5.878