Detection of colorectal neoplasms using linked color imaging: A prospective, randomized, tandem colonoscopy trial

Issei Hasegawa1, Takeshi Yamamura1, Hiroto Suzuki1, Keiko Maeda2, Tsunaki Sawada2, Yasuyuki Mizutani1, Eri Ishikawa1, Takuya Ishikawa1, Naomi Kakushima 1, Kazuhiro Furukawa1, Eizaburo Ohno1, Hiroki Kawashima2, Masanao Nakamura1, Mitsuhiro Fujishiro1

Clin Gastroenterol Hepatol. 2021 Apr 8;S1542-3565(21)00392-X. doi: 10.1016/j.cgh.2021.04.004. Online ahead of print.

Background and aims: A higher adenoma detection rate (ADR) has been shown to be related to a lower incidence and mortality of colorectal cancer. We analyzed the efficacy of linked color imaging (LCI) by assessing the detection, miss, and visibility of various featured adenomas as compared with white light imaging (WLI).

Methods: This was a prospective, randomized, tandem trial. The participants were randomly assigned to two groups: first observation by LCI, then second observation by WLI (LCI group); or both observations by WLI (WLI group). Suspected neoplastic lesions were resected after magnifying image-enhanced endoscopy. The primary outcome was to compare the ADR during the first observation. Secondary outcomes included evaluation of adenoma miss rate (AMR) and visibility score.

Results: Seven-hundred eighty patients were randomized, 700 of whom were included in the final analysis. The ADR was 69.6% and 63.2% in the LCI and WLI groups, respectively, with no significant difference. However, LCI improved the average ADR in low-detectors compared to high-detectors (76.0% vs 55.1%; P < 0.001). Total AMR was 20.6% in the LCI group, which was significantly lower than that in the WLI group (31.1%) (P < 0.001). AMR in the LCI group was significantly lower, especially for diminutive adenomas (23.4% vs 35.1%; P < 0.001) and non-polypoid lesions (25.6% vs 37.9%; P < 0.001) compared to the WLI group.

Conclusion: Although both methods provided a similar ADR, LCI had a lower AMR than WLI. LCI could benefit endoscopists with lower ADR, an observation that warrants additional study.

1 Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
2 Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan