Hiramatsu T, Nishizawa T, Kataoka Y, Yoshida S, Matsuno T, Mizutani H, Nakagawa H, Ebinuma H, Fujishiro M, Toyoshima O. Improved visibility of colorectal tumor by texture and color enhancement imaging with indigo carmine. World J Gastrointest Endosc 2023; 15(12): 690-698 [PMID: 38187913 DOI: 10.4253/wjge.v15.i12.690]
Corresponding Author of This Article
Toshihiro Nishizawa, MD, PhD, Professor, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Hatakeda 852, Narita, Chiba, Narita 286-8520, Japan. nisizawa@kf7.so-net.ne.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Takuma Hiramatsu, Hiroya Mizutani, Hideki Nakagawa, Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Toshihiro Nishizawa, Hirotoshi Ebinuma, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
Yosuke Kataoka, Shuntaro Yoshida, Tatsuya Matsuno, Osamu Toyoshima, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Author contributions: Hiramatsu T and Nishizawa T drafted the article; Hiramatsu T and Toyoshima O reviewed endoscopic images; Hiramatsu T edited endoscopic images; Nishizawa T contributed to the review of endoscopic and statistical analysis; Kataoka Y, Yoshida S, Matsuno T, Mizutani H, Nakagawa H, Ebinuma H, and Fujishiro M participated in the critical review and final manuscript approval; Toyoshima O involved in the conception of article, taking endoscopic images, review of endoscopic images, and final manuscript approval.
Institutional review board statement: Our study was approved by the ethics committee of the Certified Institutional Review Board of the Yoyogi Mental Clinic (certificate number. RKK227).
Informed consent statement: We published the study protocol on our clinic’s website (www.ichou.com), allowing patients to opt out of the study if desired. Written consent to participate in the study was obtained before endoscopy.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshihiro Nishizawa, MD, PhD, Professor, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Hatakeda 852, Narita, Chiba, Narita 286-8520, Japan. nisizawa@kf7.so-net.ne.jp
Received: September 21, 2023 Peer-review started: September 21, 2023 First decision: October 24, 2023 Revised: October 25, 2023 Accepted: November 24, 2023 Article in press: November 24, 2023 Published online: December 16, 2023 Processing time: 84 Days and 12.8 Hours
Abstract
BACKGROUND
Accurate diagnosis and early resection of colorectal polyps are important to prevent the occurrence of colorectal cancer. However, technical factors and morphological factors of polyps itself can lead to missed diagnoses. Image-enhanced endoscopy and chromoendoscopy (CE) have been developed to facilitate an accurate diagnosis. There have been no reports on visibility using a combination of texture and color enhancement imaging (TXI) and CE for colorectal tumors.
AIM
To investigate the visibility of margins and surfaces with the combination of TXI and CE for colorectal lesions.
METHODS
This retrospective study included patients who underwent lower gastrointestinal endoscopy at the Toyoshima Endoscopy Clinic. We extracted polyps that were resected and diagnosed as adenomas or serrated polyps (hyperplastic polyps and sessile serrated lesions) from our endoscopic database. An expert endoscopist performed the lower gastrointestinal endoscopies and observed the lesion using white light imaging (WLI), TXI, CE, and TXI + CE modalities. Indigo carmine dye was used for CE. Three expert endoscopists rated the visibility of the margin and surface patterns in four ranks, from 1 to 4. The primary outcomes were the average visibility scores for the margin and surface patterns based on the WLI, TXI, CE, and TXI + CE observations. Visibility scores between the four modalities were compared by the Kruskal-Wallis and Dunn tests.
RESULTS
A total of 48 patients with 81 polyps were assessed. The histological subtypes included 50 tubular adenomas, 16 hyperplastic polyps, and 15 sessile serrated lesions. The visibility scores for the margins based on WLI, TXI, CE, and TXI + CE were 2.44 ± 0.93, 2.90 ± 0.93, 3.37 ± 0.74, and 3.75 ± 0.49, respectively. The visibility scores for the surface based on WLI, TXI, CE, and TXI + CE were 2.25 ± 0.80, 2.84 ± 0.84, 3.12 ± 0.72, and 3.51 ± 0.60, respectively. The visibility scores for the detection and surface on TXI were significantly lower than that on CE but higher than that on WLI (P < 0.001). The visibility scores for the margin and surface on TXI + CE were significantly higher than those on CE (P < 0.001). In the sub-analysis of adenomas, the visibility for the margin and surface on TXI + CE was significantly better than that on WLI, TXI, and CE (P < 0.001). In the sub-analysis of serrated polyps, the visibility for the margin and surface on TXI + CE was also significantly better than that on WLI, TXI, and CE (P < 0.001).
CONCLUSION
TXI + CE enhanced the visibility of the margin and surface compared to WLI, TXI, and CE for colorectal lesions.
Core Tip: The visibility of colorectal tumors was investigated using texture and color enhancement imaging (TXI) and chromoendoscopy (CE). The combination of TXI and CE showed higher visibility than white-light imaging, TXI, or CE alone for the margins and surfaces of colorectal adenomas and serrated polyps.
