Impact of linked color imaging on the 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. Our aim was to evaluate the impact of linked color imaging (LCI) on the proximal adenoma miss rate (pAMR) in routine colonoscopy. Design and methods This national multicenter tandem randomized trial compared 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 of the hepatic flexure) were made with WLI and LCI by the same operator. First-pass examination by WLI or LCI was randomized 1:1 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 pAMR. Secondary outcomes were the proximal sessile serrated lesion miss rate (pSSLMR), the proximal advanced adenoma miss rate (pAdvAMR), and the proximal polyp miss rate (pPMR). Results 764 patients were included from January 1, 2020 to December 22, 2022. 686 patients were randomized (WLI-first group: 345 versus LCI-first group: 341). Both groups were comparable in terms of demographics and indications. pAMR was not significantly higher in the WLI-first group (36.7%) versus the LCI-first group (31.8%) (estimated mean absolute difference: 4.9% [-5.2%; 15.0%], P=0.340). There was no significant difference regarding pSSLMR, pAdvAMR, and pPMR. Conclusions In contrast to previous data, this study does not support the benefit of LCI regarding pAMR in routine colonoscopy. ClinicalTrials.gov ID: NCT04440865

Publication History

Received: 05 January 2024

Accepted after revision: 13 May 2024

Accepted Manuscript online:
13 May 2024