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Publications – LCI

Linked color imaging improves the endoscopic visibility of gastric mucosal cancers.

Kitagawa Y1, Suzuki T1, Hara T2, Nankinzan R1, Takashiro H1, Sugita O1, Imazeki H3, Yamaguchi T3.

Endosc Int Open. 2019 Feb;7(2):E164-E170. doi: 10.1055/a-0733-7086. Epub 2019 Jan 18.

Background and study aims: As a newly developed endoscopy technique, linked color imaging (LCI) provides very bright images with enhanced color tones. With the objective of improving the detection rate of gastric mucosal cancers, which are often difficult to detect, we examined the utility of LCI from the viewpoint of visibility.

Patients and methods: The current study used 100 consecutive gastric mucosal cancers ≤ 20 mm in diameter. For each lesion, we selected one endoscopic image acquired by white-light imaging (WLI), blue-laser imaging (BLI) -bright, and LCI modes. Four endoscopists interpreted the images; using a previously reported scale, we scored the visibility level on a scale of 1 - 4.

Results: The mean (± SD) visibility scores were 2.54 ± 1.10 for WLI, 3.02 ± 1.07 for BLI-bright, and 3.28 ± 0.97 for LCI. The score was significantly higher for BLI-bright compared with WLI ( P  < .001) and again higher for LCI compared with BLI-bright ( P  < .001). For the experts, the scores for BLI-bright and LCI were similar, but both were significantly higher than the score for WLI. For the trainees, there was no significant difference between the WLI and BLI-bright scores, but LCI score was significantly higher than those for WLI and BLI-bright scores. With regard to clinical characteristics, LCI particularly enhanced visibility of normochromic, flat and depressed lesions, which had the lowest visibility scores of all three modalities compared with those of the other lesions.

Conclusion: LCI increased visibility and may contribute to early detection of gastric mucosal cancers.

1 Endoscopy Division, Chiba Cancer Center, Chiba, Japan
2 Hara Clinic, Chiba, Japan
3 Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan

Advanced Treatment and Imaging in Colonoscopy: The Pocket-Creation Method for Complete Resection and Linked Color Imaging for Better Detection of Early Neoplastic Lesions by Colonoscopy.

Yamamoto H1, Shinozaki S2, Hayashi Y1, Miura Y1, Khurelbaatar T1, Osawa H1, Lefor AK3.

Clin Endosc. 2019 Jan 10. doi: 10.5946/ce.2018.189. [Epub ahead of print]

Early detection and resection of neoplastic lesions are key objectives to diminish colorectal cancer mortality. Resection of superficial colorectal neoplasms, cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection have all been developed and used worldwide. The pocket-creation method facilitates the resection of tumors in difficult and routine locations. Early detection is the most important first step to maximize the benefits of recent advancements in endoscopic techniques. However, the detection of small, flat-shaped, or faded color lesions remains difficult. Linked color imaging, a novel multi-light technology, facilitates the recognition of minor differences in tissue by enhancing the color contrast between early colorectal neoplasms and surrounding normal mucosa in a bright field of view. The most striking feature of linked color imaging is its ability to display the color of early neoplastic lesions as distinct from inflammatory changes, both of which have similar “redness” when viewed using white light imaging. To increase the detection rate of neoplasms, linked color imaging should be used from the outset for endoscopic observation. Early detection of superficial colorectal tumors can result in decreased mortality from colorectal cancer and maintain a good quality of life for patients.

1 Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke
2 Shinozaki Medical Clinic, Utsunomiya,
3 Department of Surgery, Jichi Medical University, Shimotsuke, Japan

Spraying l-menthol enhances gastric intestinal metaplasia in linked color imaging.

Ono S1, Ono Y2, Sakamoto N3.

Dig Endosc. 2019 Jan 28. doi: 10.1111/den.13362. [Epub ahead of print]

Recently, there have been some reports that image-enhanced endoscopy (IEE) may be useful for detection of gastric intestinal metaplasia (GIM) (1, 2). Linked color imaging (LCI) enables noninvasive detection of GIM as a lavender color, which is called lavender color sign (LCS) (3). Spraying l-menthol directly onto the gastric antral mucosa is useful for anti-peristalsis. As a secondary effect of spraying l-menthol, Mori et al. reported annular-reticular-like mucosal changes that were mucosal morphologic changes. This article is protected by copyright. All rights reserved.

1 Department of Gastroenterology, Hokkaido University Hospital, Sapporo
2 Department of Gastroenterology, Sapporo City Hospital, Sapporo
3 Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Quantitative Comparisons of Linked Color Imaging and White-Light Colonoscopy for Colorectal Polyp Analysis

Xinran Wei 1 , Jiyang Xie 1 , Wenrui He 1 , Min Min 2, Zhanyu Ma 1 and Jun Guo 1

The performance of imaging techniques has an important influence on the clinical diagnostic strategy of colorectal cancer. Linked color imaging (LCI) by laser endoscopy is a recently developed techniques, and its advantage in improving the analysis accuracy of colorectal polyps over white-light (WL) endoscopy has been demonstrated in previous clinical studies. However, there are no objective criteria to evaluate and compare the aforementioned endoscopy methods. This paper presents a new criterion, namely entropy of color gradients image (ECGI), which is based on color gradients distribution and provides a comprehensive and objective evaluating indicator of the performance of colorectal images. Our method extracts the color gradient image pairs of 143 colonoscopy polyps in the LCI-PairedColon database, which are generated with WL and LCI conditions, respectively. Then, we apply the morphological method to fix the deviation of light-reflecting regions, and the ECGI scores of sample pairs are calculated. Experimental results show that the average ECGI scores of LCI images (5.7071) were significantly higher than that of WL (4.6093). This observation is consistent with the clinical studies. Therefore, the effectiveness of the proposed criterion is demonstrated.

1 Pattern Recognition and Intelligent Systems Lab, Beijing University of Posts and Telecommunications, Beijing, China
2 Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China

Blue Laser Imaging, Blue Light Imaging, and Linked Color Imaging for the Detection and Characterization of Colorectal Tumors.

Yoshida N 1 , Dohi O 1 , Inoue K 1 , Yasuda R 1 , Murakami T 1 , Hirose R 1 , Inoue K 1 , Naito Y 1 , Inada Y 2 , Ogiso K 3 , Morinaga Y 4 , Kishimoto M4 , Rani RA 5 , Itoh Y 1 .

Gut Liver. 2018 Dec 4. doi: 10.5009/gnl18276. [Epub ahead of print]

Abstract:A laser endoscopy system was developed in 2012. The system allows blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) to be performed as modes of narrow-band light observation; these modes have been reported to be useful for tumor detection and characterization. Furthermore, an innovative endoscopy system using four-light emitting diode (LED) multilight technology was released in 2016 to 2017 in some areas in which laser endoscopes have not been approved for use, including the United States and Europe. This system enables blue light imaging (this is also known as BLI) and LCI with an LED light source instead of a laser light source. Several reports have shown that these modes have improved tumor detection. In this paper, we review the efficacy of BLI and LCI with laser and LED endoscopes in tumor detection and characterization.

1 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
2 Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto
3 Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka
4 Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
5 Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia

Linked Color Imaging and Blue Laser Imaging for Upper Gastrointestinal Screening.

Osawa H1, Miura Y1, Takezawa T1, Ino Y1, Khurelbaatar T1, Sagara Y1, Lefor AK2, Yamamoto H1.

Clin Endosc. 2018 Nov 2. doi: 10.5946/ce.2018.132. [Epub ahead of print]

White light imaging (WLI) may not reveal early upper gastrointestinal cancers. Linked color imaging (LCI) produces bright images in the distant view and is performed for the same screening indications as WLI. LCI and blue laser imaging (BLI) provide excellent visibility of gastric cancers in high color contrast with respect to the surrounding tissue. The characteristic purple and green color of metaplasias on LCI and BLI, respectively, serve to increase the contrast while visualizing gastric cancers regardless of a history of Helicobacter pylori eradication.
LCI facilitates color-based recognition of early gastric cancers of all morphological types, including flat lesions or those in an H. pylori-negative normal background mucosa as well as the diagnosis of inflamed mucosae including erosions. LCI reveals changes in mucosal color before the appearance of morphological changes in various gastric lesions. BLI is superior to LCI in the detection of early esophageal cancers and abnormal findings of microstructure and microvasculature in close-up views of upper gastrointestinal cancers. Excellent images can also be obtained with transnasal endoscopy. Using a combination of these modalities allows one to obtain images useful for establishing a diagnosis. It is important to observe esophageal cancers (brown) using BLI and gastric cancers (orange) surrounded by intestinal metaplasia (purple) and duodenal cancers (orange) by LCI.

1 Division of Gastroenterology, Department of Medicine
2 Department of Surgery, Jichi Medical University, Shimotsuke, Japan