Improved Visibility of Barrett’s Esophagus with Linked Color Imaging: Inter- and Intra-Rater Reliability and Quantitative Analysis.

Takeda T1, Nagahara A2, Ishizuka K1, Okubo S1, Haga K1, Suzuki M1, Nakajima A1, Komori H1, Akazawa Y1, Izumi K1, Matsumoto K1, Ueyama H1, Shimada Y1, Matsumoto K1, Asaoka D1, Shibuya T1, Sakamoto N1, Osada T1, Hojo M1, Nojiri S3, Watanabe S1.

Digestion. 2018 Jan 10;97(2):183-194. doi: 10.1159/000485459. [Epub ahead of print]

Background/Aims: To evaluate the usefulness of linked color imaging (LCI) and blue LASER imaging (BLI) in Barrett’s esophagus (BE) compared with white light imaging (WLI).

Methods: Five expert and trainee endoscopists compared WLI, LCI, and BLI images obtained from 63 patients with short-segment BE. Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and one (decreased). Scores were evaluated to assess visibility. The inter- and intra-rater reliability (intra-class correlation coefficient) of image assessments were also evaluated. Images were objectively evaluated based on L* a* b* color values and color differences (ΔE*) in a CIELAB color space system.

Results: Improved visibility compared with WLI was achieved for LCI: 44.4%, BLI: 0% for all endoscopists; LCI: 55.6%, BLI: 1.6% for trainees; and LCI: 47.6%, BLI: 0% for experts. The visibility score of trainees compared with experts was significantly higher for LCI (p = 0.02). Intra- and inter-rater reliability ratings for LCI compared with WLI were “moderate” for trainees, and “moderate-substantial” for experts. The ΔE* revealed statistically significant differences between WLI and LCI.

Conclusion: LCI improved the visibility of short-segment BE compared with WLI, especially for trainees, when evaluated both subjectively and objectively.

1 Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
2 Department of Gastroenterology, Juntendo Sizuoka Hospital, Sizuoka, Japan.
3 Department of Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo, Japan.