IMPACT OF LINKED COLOR IMAGING ON PROXIMAL ADENOMA MISS RATE: A MULTICENTER TANDEM RANDOMIZED CONTROLLED TRIAL. THE COCORICO TRIAL.

Objectives
Missed lesions are common during standard colonoscopy and are correlated with post-colonoscopy colorectal cancer (PCCRC). Contrast enhanced technologies have recently been developed to improve polyp detection. The aim of this study was to evaluate the impact of linked color imaging (LCI) system on the proximal adenoma miss rate (pAMR) in routine colonoscopy.
Design and methods
This national multicentric tandem randomized trial compared of the outcomes of standard colonoscopy with white light imaging (WLI) to colonoscopy with LCI (Fujifilm), for polyp detection in the right colon. Two consecutive examinations of the right colon (upstream the hepatic flexure) were made with WLI and LCI by the same operator. First pass inspection by WLI or LCI were randomized 1:1 (WLI–first group vs LCI–first group) after cecal intubation. According to statistical calculations, 10 endoscopy units had to include approximately 700 patients with a 1:1 randomization. The primary outcome was the pAMR. Secondary outcomes were proximal sessile serrated lesion miss rate (pSSLMR), proximal advanced AMR (pAdvAMR), and proximal polyp miss rate (PMR).
Results
A total of 764 patients were included from January 1, 2020 to December 22, 2022. 686 patients were randomized (345 for WLI-first group vs. 341 for LCI-first). Both groups were comparable in terms of demographics and indications.
pAMR was not significantly higher in the WLI-first group than in the LCI-first group: 36.7% vs 31.8%, respectively (estimated mean absolute difference: 4.9% [-5.2%; 15.0%], P=0.340).
There was no significant difference regarding pSSLMR, pAdvAMR, and pPMR between the two groups.
Conclusions
This large national multicenter randomized study does not support the benefits of LCI regarding pAMR in routine colonoscopy.
ClinicalTrials.gov ID: NCT04440865