# Comparison of adenoma detection rate using the novel 5-LED vs xenon-light endoscopic system: Propensity score matching analysis

## TL;DR

A new endoscopic system with a 5-LED and CMOS sensor may improve detection of colorectal adenomas compared to older systems.

## Contribution

The study evaluates a new endoscopic system with a CMOS sensor for improved adenoma detection in colonoscopies.

## Key findings

- The X1 system showed higher adenomas per colonoscopy and polyps per colonoscopy compared to the LUCERA system.
- Scopes with CMOS sensors in the X1 group had a significantly higher adenoma detection rate than those without.
- Polyps detected with CMOS scopes were smaller on average than those detected with CCD scopes.

## Abstract

Olympus’s new endoscopic system, EVIS X1, features five-LED illumination and a novel complementary metal-oxide-semiconductor (CMOS) image sensor distinct from conventional charge-coupled devices (CCDs), potentially improving colorectal adenoma detection rates (ADRs). This study compared ADR and related indicators between the EVIS X1 system and the conventional EVIS LUCERA ELITE, a xenon-light system.

Of 4,915 colonoscopies performed between September 2020 and April 2023, 814 EVIS X1 and 953 LUCERA cases met inclusion criteria. After propensity score matching to balance baseline characteristics, 660 patients per group were analyzed. Outcomes included ADR, polyp detection rate (PDR), adenomas per colonoscopy (APC), and polyps per colonoscopy (PPC). Subgroup analysis assessed the impact of CMOS-equipped scopes within the X1 group.

ADR was slightly higher in the X1 group (36.1%) than the LUCERA group (32.1%), although not statistically significant (
P
= 0.147). APC (0.77 vs. 0.61,
P
= 0.034) and PPC (0.95 vs. 0.75,
P
= 0.023) were significantly higher with X1. Within the X1 group, scopes with CMOS sensors achieved a significantly higher ADR (41.9%) compared with those without. Mean size of polyps detected was smaller with CMOS than with CCD scopes. Multivariate analysis identified age > 60 years, male sex, positive fecal occult blood test, and use of the X1 system with CMOS scopes as independent predictors of higher ADR.

The EVIS X1 system may have the potential to improve adenoma detection, particularly when used with CMOS sensor-equipped scopes. These findings suggest potential benefits for colorectal cancer screening, although further large-scale studies are warranted for validation.