ABSTRACT

Background: The adenoma detection rate (ADR) indicates colonoscopy quality. White light imaging (WLI) often fails to identify small/flat adenomas. Spectral focused imaging (SFI) utilizes multiple narrow-band wavelengths to enhance mucosal visualization. Here, the diagnostic performance of SFI and high-definition WLI were firstly compared, focusing on ADR.

Methods: This prospective, parallel-arm, randomized controlled trial was undertaken in eight endoscopy centers. Participants (aged 45–85 years) were randomly allocated (1:1) to SFI and high-definition WLI groups. The primary endpoint was ADR, while secondary endpoints included the polyp detection rate (PDR), advanced ADR (aADR), and the average adenoma number per colonoscopy (APC). Subgroup analyses compared detection of lesions differing in size, morphology, and anatomical location.

Results: Six hundred and ninety-eight patients were allocated to groups (SFI: n = 350; WLI: n = 348). The ADR was markedly greater in the SFI group (38.29% vs. 30.46%; P = 0.030), as were secondary measures: PDR (56.29% vs. 47.99%; P = 0.028), aADR (6.57% vs. 3.16%; P = 0.036), and APC (0.74 vs. 0.51; P = 0.021). Subgroup analysis indicated that SFI was superior in detecting right-sided adenomas (17.71% vs. 11.78%; P = 0.027), diminutive lesions ≤5 mm (28.86% vs. 19.54%; P = 0.004), and flat adenomas (22.86% vs. 16.67%; P = 0.040).

Conclusions: SFI was significantly more effective in adenoma detection relative to high-definition WLI, particularly for right-colon and small/flat lesions. These findings support the use of SFI in routine endoscopy to enhance colonoscopy quality and the early detection of malignancy (ClinicalTrials.gov, NCT06603948).