Impact of linked-color imaging on colorectal adenoma detection.

Dos Santos CEO1, Malaman D1, Pereira-Lima JC2, de Quadros Onófrio F2, Ribas Filho JM3.

Gastrointest Endosc. 2019 Jul 11. pii: S0016-5107(19)32052-8. doi: 10.1016/j.gie.2019.06.045. [Epub ahead of print]

Background and aims: Linked-color imaging (LCI) is a new technology that emphasizes changes in mucosal color by providing clearer and brighter images, thus allowing red and white areas to be more clearly visualized. We investigated whether LCI increases the detection of colorectal adenomas when compared with white-light imaging (WLI) and blue-laser imaging (BLI)-bright.

Methods: Consecutive patients undergoing colonoscopy were randomized (1:1:1) into examination by WLI, BLI-bright, or LCI during withdrawal of the colonoscope. The adenoma detection rate (ADR), mean number of adenomas per patient, and withdrawal time were evaluated. The lesions were evaluated according to size, morphology, location, and histology.

Results: A total of 379 patients were randomized, and 412 adenomas were detected. ADR was 43.2%, 54.0%, and 56.9% for WLI, BLI-bright, and LCI, respectively, being significantly higher in the LCI group than in the WLI group (P=0.03). No significant difference was observed between LCI and BLI-bright (P=0.71) or BLI-bright and WLI (P=0.09). The mean number of adenomas per patient was 0.82, 1.06, and 1.38 for WLI, BLI-bright, and LCI, respectively, with a significant difference between LCI and WLI (P=0.03). Withdrawal time did not differ between groups. A total of 102 adenomas were detected by WLI, 131 by BLI-bright, and 179 by LCI. LCI provided a higher rate of detection of adenomas ≤ 5 mm in size than WLI (P=0.02), with a borderline significance for a higher detection of sessile serrated adenomas (P=0.05). Nonpolypoid adenomas were more commonly located in the right colon segment and polypoid adenomas in the left colon segment, with a significant difference only between BLI-bright (P<0.01) and LCI (P=0.03).

Conclusions: Our findings show that LCI increases the detection of colorectal adenomas during colonoscopy.

1 Department of Endoscopy and Gastroenterology, Santa Casa de Caridade Hospital, Bagé, RS, Brazil.
2 Department of Gastroenterology and Endoscopy, Santa Casa Hospital, Porto Alegre, RS, Brazil.
3 Postgraduate Program in Principles of Surgery, Faculdade Evangélica do Paraná, Curitiba, PR, Brazil.