Clinical usefulness of endoscopic assessment in ulcerative colitis using linked color imaging: a preliminary pilot study with 10 patients

Background and Aims. Missed polyps are a pitfall of colonoscopy. In this study, we analyzed the efficacy of an additional 30 seconds observation using linked color imaging (LCI) for detecting adenoma and sessile serrated adenoma/polyp (SSA/P). Materials and Methods. We enrolled patients undergoing colonoscopy from February to October 2017 in two institutions. In all patients, the cecum and ascending colon were observed with white light imaging (WLI) first. The colonoscope was inserted again, and the cecum and ascending colon were observed for an additional 30 seconds using either LCI or WLI. The method for the 30 sec observation was to insufflate the cecum and ascending colon sufficiently and observe them in a distant view, because the length of the second observation was determined to be precisely 30 sec. For the second observation, LCI was performed for the first 65 patients and WLI for the next 65. Adenoma and SSA/P detection rate (ASDR) in the second observation were examined in both groups. According to a pilot study, the sample size was estimated 65. Results. In the first observation, ASDR were 30.7% in the LCI group and 32.2% in the WLI group (p=0.85). For the second observation, 13 polyps were detected in the LCI group and 5 polyps in the WLI group (p=0.04). Additionally, ASDR for the second observation were 18.5% and 6.1%, respectively (p=0.03). There were no significant differences between the LCI and WLI groups with respect to morphology (ratio of polypoid) (38.5% versus 60.0%, p=0.52) and histology (ratio of adenoma) (92.3% versus 100.0%, p=0.91). Total adenoma and SSA/P number were 48 in the LCI group and 36 in the WLI group (p=0.02). Conclusion. The 30 seconds additional observation with LCI improved the detection of adenoma and SSA/P in the right-sided colon.

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Diagnostic utility of linked color imaging in the evaluation of colonic mucosal inflammation in ulcerative colitis: a pilot study

Endoscopy International Open ◽

10.1055/a-0810-0398 ◽

2019 ◽

Vol 07 (08) ◽

pp. E937-E943 ◽

Cited By ~ 1

Author(s):

Shuji Kanmura ◽

Hitomi Hamamoto ◽

Akihito Tanaka ◽

Shiho Arima ◽

Fumisato Sasaki ◽

...

Keyword(s):

Ulcerative Colitis ◽

Region Of Interest ◽

Mucosal Healing ◽

Mucosal Inflammation ◽

Color Imaging ◽

Intestinal Activity ◽

Average Color ◽

Color Value ◽

The Difference ◽

Linked Color Imaging

Abstract Background and aims Recent studies recommend histological mucosal healing of intestinal tissue as a treatment goal in ulcerative colitis (UC). Linked-color imaging (LCI) is a new endoscopy system that enhances the color differences of the gastrointestinal mucosa. We investigated the efficacy of LCI in the evaluation of intestinal activity, including the histological activity in UC. Method A total of 21 UC patients who were evaluated by the LASEREO system (FUJIFILM Co., Tokyo, Japan) were enrolled from August to December in 2016. All of the target points were observed by conventional white-light imaging (WLI) and LCI and biopsied from the region of interest in each view. We quantified the color tones of 73 biopsied points on WLI and LCI using the L*a*b* color value (WLI-L, WLI-a, WLI-b, and LCI-L, LCI-a, LCI-b). We then investigated the relationships among the L*a*b* color values, endoscopic findings, and histological healing. Results The average LCI-a and LCI-b values of patients with high mucosal activity disease were significantly higher than in those with mucosal healing (P < 0.01), and only LCI-a was significantly correlated with the score for histological healing. With regard to the other color values (LCI-L and all WLI values), there were no statistically significant differences in terms of average color value and correlation between patients with high mucosal activity and those with mucosal healing. In addition, the difference in the average color values with LCI and WLI was 7.1 and 3.1, respectively. Conclusion LCI is more useful than WLI for the visualization and evaluation of mucosal inflammation in UC.

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Significance of Linked Color Imaging for Predicting the Risk of Clinical Relapse in Ulcerative Colitis

Gastroenterology Research and Practice ◽

10.1155/2020/3108690 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Shuji Kanmura ◽

Akihito Tanaka ◽

Kazuki Yutsudou ◽

Kosuke Kuwazuru ◽

Fukiko Komaki ◽

...

Keyword(s):

Ulcerative Colitis ◽

Relapse Rate ◽

Additional Treatment ◽

Chronic Inflammatory Bowel Disease ◽

Unknown Etiology ◽

Clinical Relapse ◽

Color Imaging ◽

Significant Difference ◽

Linked Color Imaging

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with unknown etiology. Recently, mucosal healing has emerged as an important therapeutic endpoint in UC. Linked color imaging (LCI) is a novel endoscopic system that enhances the color differences of the gastrointestinal mucosa. Our previous study emphasized the redness and yellowness of the lesion using LCI observation, which was useful for the evaluation of histological mucosal activity in UC. In this study, we aimed to evaluate the correlation between LCI observation and clinical relapse rate in UC patients. We retrospectively analyzed UC patients who underwent total colonoscopy between August 2016 and October 2018 at our facility with Mayo endoscopic scores of 0 or 1. We assessed the correlation between orange-like color lesion (defined as LCI-scarlet color lesions) and clinical relapse rate (requiring additional treatment for UC) during the 1-year follow-up period. Fifty-eight patients (22 female, 36 male; median age at diagnosis, 47.2 (18–80) years) who underwent colonoscopy were analyzed. During the 1-year follow-up period, clinical relapse was observed in 12 patients (20.1%) among which ten patients (83.3%) had an LCI-scarlet color lesions recognized by LCI. By contrast, 29 patients (63%) had no LCI-scarlet color lesions in the clinical remission group (n=46). There was a significant difference in LCI-scarlet color between the clinical relapse and remission groups, remaining significantly associated with clinical relapse. LCI findings, including an orange-like color lesion, have diagnostic implications for predicting the risk of clinical relapse in UC during the 1-year follow-up period.

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