BACKGROUND Colonoscopy is the criterion standard for screening of colorectal neoplasms. Nonetheless, a substantial miss rate with conventional, white-light colonoscopy (WL) remains a challenge.

OBJECTIVE To assess whether Fuji Intelligent Color Enhancement (FICE) can detect more adenomas than WL in screening colonoscopy.

DESIGN Prospective, randomized trial of tandem colonoscopy adjusted for withdrawal time and lavage effect.

SETTING Seoul National University Hospital Healthcare System Gangnam Center, Korea.

PATIENTS This study involved 359 average-risk adults undergoing screening colonoscopy.

INTERVENTION Patients were randomized to the first withdrawal with either FICE (FICE-WL group) or WL (WL-FICE group).

MAIN OUTCOME MEASUREMENTS The primary end point measure was the difference in adenoma miss rates, and the secondary outcome measure was the adenoma detection rate.

RESULTS We enrolled 359 patients (mean age 50.6 years, male 66.9%) and randomly assigned 181 to the WL-FICE group and 178 to the FICE-WL group. The number of adenomas detected by FICE and WL was 123 and 107, respectively. The adenoma miss rate with FICE showed no significant difference compared with that of WL (6.6% vs 8.3%, P = .59). Characteristics of lesions missed by use of FICE were similar to those missed by use of WL; 93% of overall missed polyps were < or =5 mm, and none were > or =1 cm. All missed adenomas were low grade and nonpedunculated. There was no significant difference between FICE and WL in adenoma detection rate (mean 0.64 vs 0.55 per patient, P = .65) nor percentage of patients with > or =1 adenoma (33.7% vs 30.4%, P = .74).

LIMITATIONS Single-center study.

CONCLUSION FICE at screening colonoscopy did not improve the adenoma miss rate or detection rate compared with WL.