Comparative Performance of Image-Enhanced Endoscopy for Adenoma and Sessile Serrated Lesion Detection: A Network Meta-Analysis
In brief
Linked color imaging raises adenoma detection by one in 17 colonoscopies
A network meta-analysis of 53 trials (34,364 patients) found that linked color imaging increased adenoma detection rate compared with standard white-light endoscopy, needing to screen 17 patients to find one extra adenoma. It also improved sessile serrated lesion detection (one extra lesion per 29 screens). Differences between IEE methods were modest, and confidence was moderate.
- Journal
- Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (Q1)
- Published
- 1 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Satoshi Shinozaki, Jun Watanabe, Tomonori Yano
- PMID
- 42608031
- DOI
- 10.1111/den.70262
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 23 August 2026): Network meta-analysis of adenoma detection rates
Abstract
BACKGROUND AND AIMS: Image-enhanced endoscopy (IEE) technologies have been developed to improve colorectal polyp detection, but their comparative efficacy remains uncertain. We performed a network meta-analysis to compare the efficacy of major IEE modalities on colorectal polyp detection. METHODS: We searched MEDLINE, Embase, and CENTRAL for randomized controlled trials comparing seven IEE modalities (autofluorescence imaging, blue-light imaging, flexible spectral imaging color enhancement, i-scan, linked color imaging [LCI], narrow band imaging [NBI], and texture and color enhancement imaging [TXI]) with white-light imaging (WLI). The primary outcome was the comparison of performance of IEE systems in adenoma detection rate (ADR); the secondary outcome was sessile serrated lesion detection rate (SSLDR). We estimated the number needed to screen (NNS) with 95% credible intervals (CrIs). Study credibility was assessed using the Confidence in Network Meta-analysis (CINeMA) framework. RESULTS: Fifty-three randomized controlled trials encompassing 34,364 patients were included. Compared with WLI, moderate-confidence evidence supported improvements in ADR with TXI (NNS 13, 95% CrIs 7-32), LCI (NNS 17, 95% CrIs 11-31), and NBI (NNS 35, 95% CrIs 18-139), whereas low-confidence evidence supported benefits for i-scan (NNS 7, 95% CrIs 3-18). Direct comparison across IEEs demonstrated little-to-no clinically meaningful differences in ADR. For SSLDR, moderate-confidence evidence supported improvements with LCI (NNS 29, 95% CrIs 15-96) and NBI (NNS 38, 95% CrIs 19-143) compared with WLI. CONCLUSIONS: LCI demonstrated the most robust and reproducible performance across multiple analyses with moderate-confidence evidence, although differences among IEE modalities were generally modest.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.