Ono S, Abiko S, Kato M. etc

Dig Endosc. 2017 Mar;29(2) Impact factor 2.715

Gastric intestinal metaplasia (GIM) is a high-risk condition for intestinal-type gastric cancer; however, there is a limitation for detection of GIMusing white light imaging (WLI). Image-enhanced endoscopy (IEE) is more advantageous than WLI for optical diagnosis of GIM.¹ Linked colorimaging (LCI; FUJIFILM Co., Tokyo, Japan) was newly developed for advanced IEE and enables visualization of red lesions that appear redder and whitish red lesions that appear whiter during routine endoscopy.² GIM is observed as a lavender color that is distinguishable from the circumferential mucosa without GIM by using LCI (Fig. 1). We speculate that the lavender color is the same as the bluish–whitish patchy areas including a light blue crest or a marginal turbid band in narrow band imaging.^3,4 In contrast, gastric cancer is observed as lesions of various degrees of redness depending on the quantity of blood vessels.

Awoman in her 70s received screening esophagogastroduodenoscopy in the 7th year after Helicobacter pylori eradication. At first, neither abnormal lesions nor GIM were detected in the antrum by WLI, but a 10mm slightly reddish depressed lesion in a lavender color area was observed by LCI (Fig. 2a,b). A biopsy specimen from this lesion revealed well-differentiated tubular adenocarcinoma, and endoscopic submucosal dissection (ESD) was therefore carried out. Histologically, GIM surrounded the intramucosal adenocarcinoma (Fig. 2c,d).

The present case showed an important advantage of LCI during routine endoscopy. GIM, which is a high-risk condition for gastric cancer, was easily detected by LCI as a lavender color. Furthermore, LCI enhanced a gastric cancer in GIM. LCI would be a useful tool for detection of gastric cancer in high-risk patients.