Shinji Kitamura, Tomoyuki Koike, Shinichiro Hori, Hiromitsu Kanzaki, Takahisa Murao, Nobuaki Yagi, Fumisato Sasaki, Keiichi Hashiguchi, Shiro Oka, Kazuhiro Katada, Ryo Shimoda, Kazuhiro Mizukami, Mitsuhiko Suehiro, Toshihisa Takeuchi, Shinichi Katsuki, Momoko Tsuda, Yuji Naito, Tatsuyuki Kawano, Ken Haruma, Hideki Ishikawa, Keita Mori, Mototsugu Kato

Annals of Internal Medicine 2020 Oct

Background: Linked color imaging (LCI) is a new image-enhanced endoscopy technique that allows users to recognize slight differences in mucosal color.

Objective: To compare the performance of LCI with white light imaging (WLI) in detecting neoplastic lesions in the upper gastrointestinal tract.
Design:A controlled, multicenter trial with randomization using minimization. (University Hospital Medical Information Network Clinical Trials Registry: UMIN000023863)
Setting:16 university hospitals and 3 tertiary care hospitals in Japan.
Patients:1502 patients with known previous or current cancer of the gastrointestinal tract and undergoing surveillance for gastrointestinal cancer.

Measurements: Diagnosis of 1 or more neoplastic lesions in the pharynx, esophagus, or stomach in the first examination (primary outcome) and 1 or more neoplastic lesions overlooked in the first examination (secondary outcome).

Results: 752 patients were assigned to the WLI group and 750 to the LCI group. The percentage of patients with 1 or more neoplastic lesions diagnosed in the first examination was higher with LCI than with WLI (60 of 750 patients or 8.0% [95% CI, 6.2% to 10.2%] vs. 36 of 752 patients or 4.8% [CI, 3.4% to 6.6%]; risk ratio, 1.67 [CI, 1.12 to 2.50; P = 0.011]). The proportion with overlooked neoplasms was lower in the LCI group than in the WLI group (5 of 750 patients or 0.67% [CI, 0.2% to 1.6%] vs. 26 of 752 patients or 3.5% [CI, 2.3% to 5.0%]; risk ratio, 0.19 [CI, 0.07 to 0.50]).

Conclusion: LCI is more effective than WLI for detecting neoplastic lesions in the pharynx, esophagus, and stomach.

1 Hokkaido University Hospital, Sapporo, Japan (S.O., M.T.)
2 Tokyo Medical and Dental University, Tokyo, Japan (K.K.)
3 Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan (O.D., Y.N.)
4 Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan (S.K.)
5 Tohoku University Graduate School of Medicine, Sendai, Japan (T.K.)
6 National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan (S.H.)
7 Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences, Okayama, Japan (H.K.)
8 Kawasaki Medical School, Okayama, Japan (T.M.)
9 Asahi University Hospital, Gifu, Japan (N.Y.)
10 Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (F.S.)
11 Nagasaki University Hospital, Nagasaki, Japan (K.H.)
12 Hiroshima University Hospital, Hiroshima, Japan (S.O.)
13 North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K.)
14 Saga University, Saga, Japan (R.S.)
15 Oita University, Oita, Japan (K.M.)
16 Kawasaki Medical School General Medical Center, Okayama, Japan (M.S.,K.H.)
17 Osaka Medical College, Osaka, Japan (T.T.)
18 Otaru Ekisaikai Hospital, Otaru, Japan (S.K.)
19 Soka Municipal Hospital, Soka,Japan (T.K.)
20 Kyoto Prefectural University of Medicine, Osaka, Japan (H.I.)
21 Shizuoka Cancer Center, Shizuoka, Japan (K.M.)
22 National Hospital Organization Hakodate National Hospital, Hakodate, Japan (M.K.).