Linked
                    color imaging improves detection of minimal change esophagitis in non-erosive
                    reflux esophagitis patients

Abstract Background and study aims Non-erosive reflux disease (NERD) includes minimal change esophagitis (MCE) and no endoscopic abnormalities. However, for most endoscopists, it is difficult to detect MCE with conventional white-light endoscopy (WLE). Linked color imaging (LCI) technology is the most recently developed image-enhancing technology and improves detection and differentiation of subtle mucosal changes using a color contrast method. This study assessed the efficacy of WLE combined with LCI for diagnosing MCE compared with WLE. Patients and methods Between February and May 2017, 44 NERD patients and 40 healthy subjects were enrolled in our study. First, the distal esophagus was examined using WLE followed by LCI. Second, three experienced endoscopists observed all the patients’ white-light (WL) images and corresponding images of WL and LCI and then recorded presence or absence of minimal change esophagitis (MCE +/–). The proportion of minimal change between the two groups was then compared. Third, five blinded endoscopists with different levels of endoscopic experience assessed whether MCE was present. Intraobserver reproducibility and interobserver agreement were described using the kappa value. Results The proportion of MCE in the NERD group (70.8 %, 35/48) was higher than that in the control group (22.5 %, 9/40, P < 0.001) when diagnosed by the three experienced endoscopists. Detection rates for MCE using WLE combined with LCI were higher than those using WLE (43/88, 48.9 % vs. 29/88, 33.0 %, P < 0.001). With WLE combined with LCI, intraobserver reproducibility signiﬁcantly improved, indicating that the combined approach can improve interobserver agreement compared with using WLE alone. Conclusions Endoscopic diagnosis of MCE using WLE combined with LCI images is effective. Intraobserver reproducibility and interobserver agreement in MCE can be improved when LCI is applied with conventional imaging (Clinical trial registration number: NCT03068572).

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Linked color imaging reduces the miss rate of neoplastic lesions in the right colon: a randomized tandem colonoscopy study

Endoscopy ◽

10.1055/a-0580-7405 ◽

2018 ◽

Vol 50 (04) ◽

pp. 396-402 ◽

Cited By ~ 20

Author(s):

Silvia Paggi ◽

Giuseppe Mogavero ◽

Arnaldo Amato ◽

Emanuele Rondonotti ◽

Alida Andrealli ◽

...

Keyword(s):

Color Contrast ◽

Right Colon ◽

Color Imaging ◽

Colon Adenoma ◽

Detection Rates ◽

Adenoma Detection ◽

Significant Difference ◽

Neoplastic Lesions ◽

Linked Color Imaging ◽

The Right

Abstract Background Linked color imaging (LCI) is a newly developed image-enhancing endoscopy technology that provides bright endoscopic images and increases color contrast. We investigated whether LCI improves the detection of neoplastic lesions in the right colon when compared with high definition white-light imaging (WLI). Methods Consecutive patients undergoing colonoscopy were randomized (1:1) after cecal intubation into right colon inspection at first pass by LCI or by WLI. At the hepatic flexure, the scope was reintroduced to the cecum under LCI and a second right colon inspection was performed under WLI in previously LCI-scoped patients (LCI–WLI group) and vice versa (WLI–LCI group). Lesions detected on first- and second-pass examinations were used to calculate detection and miss rates, respectively. The primary outcome was the right colon adenoma miss rate. Results Of the 600 patients enrolled, 142 had at least one adenoma in the right colon, with similar right colon adenoma detection rates (r-ADR) in the two groups (22.7 % in LCI–WLI and 24.7 % in WLI–LCI). At per-polyp analysis, double inspection of the right colon in the LCI–WLI and WLI–LCI groups resulted in an 11.8 % and 30.6 % adenoma miss rate, respectively (P < 0.001). No significant difference in miss rate was found for advanced adenomas or sessile serrated lesions. At per-patient analysis, at least one adenoma was identified in the second pass only (incremental ADR) in 2 of 300 patients (0.7 %) in the LCI – WLI group and in 13 of 300 patients (4.3 %) in the WLI – LCI group (P = 0.01). Conclusions LCI could reduce the miss rate of neoplastic lesions in the right colon.

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Linked Color Imaging vs White Light Imaging for Detection of Gastric Cancer Precursors

Case Medical Research ◽

10.31525/ct1-nct03990025 ◽

2019 ◽

Author(s):

Keyword(s):

Gastric Cancer ◽

White Light ◽

Color Imaging ◽

Linked Color Imaging ◽

Cancer Precursors ◽

White Light Imaging

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Improved adenoma detection with linked color imaging technology compared to white-light colonoscopy

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2020.1786850 ◽

2020 ◽

Vol 55 (7) ◽

pp. 877-883

Author(s):

Barbara Dorottya Lovász ◽

Milán Szalai ◽

László Oczella ◽

Ádám Finta ◽

Zsolt Dubravcsik ◽

...

Keyword(s):

White Light ◽

Color Imaging ◽

Imaging Technology ◽

Adenoma Detection ◽

Linked Color Imaging

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Linked color imaging enhances endoscopic detection of sessile serrated adenoma/polyps

Endoscopy International Open ◽

10.1055/s-0043-124469 ◽

2018 ◽

Vol 06 (03) ◽

pp. E322-E334 ◽

Cited By ~ 16

Author(s):

Daisaku Fujimoto ◽

Naoki Muguruma ◽

Koichi Okamoto ◽

Yasuteru Fujino ◽

Kaizo Kagemoto ◽

...

Keyword(s):

Detection Rate ◽

Controlled Trial ◽

Color Space ◽

Blue Laser ◽

Sessile Serrated Adenoma ◽

Serrated Adenoma ◽

Color Imaging ◽

Detection Rates ◽

Still Image ◽

Linked Color Imaging

Abstract Background and study aims Although new image-enhanced endoscopy (IEE) technologies such as blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) have been developed, their utility for the detection of sessile serrated adenoma/polyps (SSA/Ps) is still unclear. This study aimed to evaluate the utility of BLI, BLI-bright, and LCI for SSA/P detection in still image examinations and in a prospective randomized controlled trial (RCT). Patients and methods A group of 6 expert and non-expert endoscopists read 200 endoscopic still images containing SSA/P lesions using white light image (WLI), BLI, BLI-bright, and LCI. Color differences were calculated using the color space method. A prospective RCT of tandem colonoscopy with WLI and LCI was performed. Patients with SSA/P and those with a history of SSA/P that had been endoscopically removed were enrolled and randomly allocated to WLI-LCI or LCI-WLI groups. Additional endoscopic detection rates for SSA/P were compared between the 2 groups. Results LCI showed the highest SSA/P detection rate among the 4 modes for both expert and non-expert endoscopists. The detection rate with LCI for the 6 expert endoscopists (mean 98.3 ± standard deviation 2.0 %) was significantly higher than that with WLI (86.7 ± 6.0 %, P < 0.01). Likewise, the detection rate with LCI for the 6 non-expert endoscopists (92.3 ± 2.9 %) was significantly higher than that with WLI (72.7 ± 11.5 %, P < 0.01). The color difference of SSA/P with LCI was the highest among the 4 modes, and was significantly higher than with WLI (median 15.9, (interquartile range 13.7 – 20.6) vs. 10.2, (7.6 – 14.2); P < 0.0001). In the RCT, a total of 44 patients (WLI-LCI 22 vs. LCI-WLI 22) underwent colonoscopy. The additional detection rate for SSA/P in the second inspection in the WLI-LCI group (21.6 %, 8/37) was significantly higher than in the LCI-WLI group (3.2 %, 1/31; P = 0.02). The small, flat, non-mucus and isochromatic SSA/Ps in the transverse colon were detected more frequently in the second inspection with LCI. Conclusions LCI was the most sensitive mode for SSA/P detection among WLI, BLI, BLI-bright, and LCI in the still image examinations. Our RCT strongly suggests that LCI is superior to conventional WLI for SSA/P detection during colonoscopy. UMIN000017599.

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