Linked Color Imaging and the Kyoto Classification of Gastritis: Evaluation of Visibility and Inter-Rater Reliability.

Takeda T1, Asaoka D1, Nojiri S4, Nishiyama M1, Ikeda A1, Yatagai N1, Ishizuka K1, Hiromoto T1, Okubo S1, Suzuki M1, Nakajima A1, Nakatsu Y2, Komori H1, Akazawa Y1, Nakagawa Y1, Izumi K1, Matsumoto K1, Ueyama H1, Sasaki H1, Shimada Y3, Matsumoto K1, Osada T2, Hojo M1, Kato M5, Nagahara A1

Digestion. 2019 Jul 12:1-10. doi: 10.1159/000501534. [Epub ahead of print]

Background & aims: To compare white light imaging (WLI) with linked color imaging (LCI) and blue LASER imaging (BLI) in endoscopic findings of Helicobacter pylori presently infected, previously infected, and uninfected gastric mucosae for visibility and inter-rater reliability.

Methods: WLI, LCI and BLI bright mode (BLI-bright) were used to obtain 1,092 endoscopic images from 261 patients according to the Kyoto Classification of Gastritis. Images were evaluated retrospectively by 10 experts and 10 trainee endoscopists and included diffuse redness, spotty redness, map-like redness, patchy redness, red streaks, intestinal metaplasia, and an atrophic border (52 cases for each finding, respectively). Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and 1 (decreased). Visibility was assessed from totaled scores. The inter-rater reliability (intraclass correlation coefficient) was also evaluated.

Results: Compared with WLI, all endoscopists reported improved visibility with LCI: 55.8% for diffuse redness; LCI: 38.5% for spotty redness; LCI: 57.7% for map-like redness; LCI: 40.4% for patchy redness; LCI: 53.8% for red streaks; LCI: 42.3% and BLI-bright: 80.8% for intestinal metaplasia; LCI: 46.2% for an atrophic border. For all endoscopists, the inter-rater reliabilities of LCI compared to WLI were 0.73-0.87.

Conclusion: The visibility of each endoscopic finding was improved by LCI while that of intestinal metaplasia was improved by BLI-bright.

1 Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
2 Department of Gastroenterology, Juntendo University Urayasu Hospital, Chiba, Japan
3 Department of Gastroenterology, Juntendo Sizuoka Hospital, Shizuoka, Japan
4 Department of Medical Technology Innovation Center Juntendo University School of Medicine, Tokyo, Japan
5 Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan