Kitagawa Y1, Suzuki T1, Nankinzan R1, Ishigaki A2, Furukawa K2, Sugita O1, Hara T3, Yamaguchi T2
Dig Endosc. 2019 Nov 25. doi: 10.1111/den.13585. [Epub ahead of print]
Objectives: We aimed to investigate whether linked color imaging (LCI) improves the endoscopic visibility of early gastric cancers (EGCs) after Helicobacter pylori eradication, which are often difficult to detect, and reduces the miss rate when compared with white-light imaging (WLI).
Methods: The visibility study used two images, one each with WLI and LCI, from 84 consecutive EGCs after H. pylori eradication. Endoscopic visibility was evaluated using a visibility score and color difference (CD) value. To analyze the miss rates, we studied a library of recorded videos using both WLI and LCI for other 70 consecutive patients after H. pylori eradication, among whom 19 had an EGC. Endoscopic screening was performed using the same protocol to map the entire stomach. Six endoscopists reviewed the videos in a randomized order. The miss rates of EGCs were compared among the modalities.
Results: The mean (± standard deviation) visibility scores with LCI were significantly higher than those with WLI (3.19 ± 0.84 vs. 2.52 ± 0.98, P < 0.001), as were the mean CD values (26.3 ± 9.1 vs. 13.6 ± 6.3, P < 0.001). The miss rates of the six endoscopists were significantly lower with LCI than with WLI (30.7% vs. 64.9%, P < 0.001). Both expert and trainee endoscopists had significantly better results with LCI than with WLI.
Conclusions: LCI significantly improved the visibility of EGCs after H. pylori eradication compared with WLI using both subjective and objective criteria. Furthermore, LCI significantly reduced miss rates of these lesions compared with WLI.
1 Endoscopy Division, Chiba Cancer Center, Chiba, Japan
2 Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
3 Hara Clinic, Chiba, Japan