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Publications – LCI

Detection of early stage gastric cancers in screening laser endoscopy using linked color imaging for patients with atrophic gastritis

Minoru Yamaoka1, Hiroyuki Imaeda2, Kazuya Miyaguchi1, Keigo Ashitani1, Yoshikazu Tsuzuki2, Hideki Ohgo2, Hiromitsu Soma2, Nobutaka Hirooka1, Hidetomo Nakamoto1

J Gastroenterol Hepatol. 2020 Oct 30. doi: 10.1111/jgh.15312. Online ahead of print.

Background and aims: Laser endoscopy involves blue laser imaging in bright mode (BLI-bright). Linked color imaging (LCI) is superior to white light imaging (WLI) for detecting gastric cancers. This study aimed to detect gastric cancers on screening endoscopy using not only WLI but also BLI-bright and LCI in patients with atrophic gastritis.

Patients and methods: A total of 500 patients with atrophic gastritis undergoing screening esophagogastroduodenoscopy were included. The gastric lumen was observed in the WLI mode, followed by the LCI and BLI-bright modes. When gastric neoplasms were suspected, the mode was changed to WLI, and we sprayed indigo carmine. Finally, biopsy specimens were taken for those lesions and pathological diagnosis was made. We compared the size, morphology, and color of gastric neoplasms found by the first WLI mode and those detected by only the LCI mode or BLI-bright mode.

Results: We detected 16 gastric neoplasms (3.2%), of which 13 were early gastric cancers (EGCs) and three were gastric adenomas. Ten EGCs and two gastric adenomas (75%) were detected by the first WLI mode; three EGCs and one gastric adenoma (25%) were missed by the first WLI mode and were detected by the LCI mode or BLI-bright mode. All were less than 1 cm in diameter and were reddish. Mean diameter of the lesions was significantly less for LCI-detected or BLI-bright-detected lesions than for WLI-detected lesions (7.8 vs 21.2 mm).

Conclusions: Laser endoscopy is useful for detecting EGCs by LCI for patients with atrophic gastritis.

1 Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
2 Departement of Gastroenterology, Saitama Medical University, Saitama, Japan

Linked Color Imaging Focused on Neoplasm Detection in the Upper Gastrointestinal Tract

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.).

Optical effect of spraying l-menthol on gastric intestinal metaplasia visualized by linked color imaging

Ono, Shokoa1; Shimoda, Yoshihikob2; Tanaka, Ikkob2; Kinowaki, Sayokob2; Inoue, Masakib2; Ono, Masayoshib2; Yamamoto, Keikoc3; Shimizu, Yuichic3; Sakamoto, Naoya2

European Journal of Gastroenterology & Hepatology: September 9, 2020 – Volume Publish Ahead of Print – Issue –

Objective: Linked color imaging (LCI) enables noninvasive detection of gastric intestinal metaplasia (GIM) as a lavender color sign (LCS), and there has been a recent report that l-menthol enhanced GIM with LCI. We measured color values of GIM and surrounding mucosa with white light imaging (WLI), LCI and LCI after spraying l-menthol (Mint-LCI) and investigated the effect of l-menthol on gastric mucosa.

Methods: Endoscopic images of the antrum with WLI, LCI and Mint-LCI from 18 patients were prepared. Each of six regions of interest (three points of GIM and three points of surrounding mucosa) was selected for each modality, and CIE1976 (Lab) color space was used to measure the color values. The primary endpoint was color differences (ΔE) between GIM and surrounding mucosa in each modality. Results For surrounding mucosa, the mean a value with Mint-LCI was significantly higher than the mean values with WLI and LCI (P < 0.01). The mean b* value of GIM with LCI was significantly lower than that of surrounding mucosa, and spraying l-menthol decreased the b* values of GIM with a change to a deeper lavender color (LCI: 10.0 ± 5.8, Mint-LCI: 3.7 ± 6.1, P < 0.01). However, there was no significant difference in mean ΔE values between LCI and Mint LCI (LCI: 21.1 ± 6.6, Mint-LCI: 22.7 ± 5.4, NS). After spraying l-menthol, the microstructure of GIM changed to translucent and microvessels were obscured.

Conclusions: As shown by LCI, spraying l-menthol optically enhances the color of GIM in the antrum.

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

Linked Color Imaging Demonstrates Characteristic Findings in Semi-Pedunculated Gastric Adenocarcinoma in Helicobacter Pylori-Negative Normal Mucosa

Yuji Hiraoka1, Yoshimasa Miura1, Hiroyuki Osawa1, Mio Sakaguchi2, Masato Tsunoda1, Alan Kawarai Lefor3, Hironori Yamamoto1

Clin Endosc. 2020 Aug 21. doi: 10.5946/ce.2020.059. Online ahead of print.

Linked color imaging (LCI) provides bright observation suitable for screening of the entire stomach [1], and its high color contrast to the surrounding mucosa makes it easier to detect early malignant lesions [2,3]. Compared to white light imaging, LCI enhances subtle differences in the color tone by advanced post processing steps [4]. LCI has a higher emission intensity of 410 nm, which can influence the mucosal color of various lesions [1,4]. Clear images of gastric cancer have been reported in the background with a history of Helicobacter pylori infection. Here, we report a semi-pedunculated gastric adenocarcinoma in H. pylori-negative normal mucosa imaged using LCI.

1 Division of Gastroenterology, Department of Medicine, Jichi Medical University,Tochigi, Japan
2 Department of Pathology, Jichi Medical University,Tochigi, Japan
3 Department of Surgery, Jichi Medical University,Tochigi, Japan

Linked color imaging and blue light imaging for evaluating a depressed-type adenoma in the colon

Shunsuke Yamamoto1, Nima Mottacki1

Ann Gastroenterol. Jul-Aug 2020;33(4):437. doi: 10.20524/aog.2020.0466. Epub 2020 Mar 14.

A 70-year-old man with anemia attended the hospital for colonoscopy. The examination was performed using linked color imaging (LCI) and blue light imaging (BLI) with a high-definition magnifying colonoscope (EC-760ZP-VM, Fujifilm Co.). White light imaging revealed a depressed-type polyp in the ascending colon, 8 mm in size, and was assessed as 0-IIc according to the Paris classification (Fig. 1). LCI showed an enhanced image of the depressed morphology of the polyp (Fig. 1). Magnifying BLI revealed pits smaller than those seen in surrounding normal mucosa (type IIIs in Kudo classification). No signs of invasion, such as destructed pits or vessels with varied caliber, were seen (Fig. 1). Endoscopic mucosal resection was performed. The pathological diagnosis was tubular adenoma with low-grade dysplasia, as expected from the pre-treatment observation, and it was completely resected (Fig. 2).

1 Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Improved adenoma detection with linked color imaging technology compared to white-light colonoscopy

Barbara Dorottya Lovász1,2, Milán Szalai3, László Oczella1, Ádám Finta3, Zsolt Dubravcsik4, László Madácsy3

Scand J Gastroenterol. 2020 Jul 12;1-7. doi: 10.1080/00365521.2020.1786850. Online ahead of print.

Objectives: Linked color imaging (LCI) is a new endoscopic technology that may increase colorectal adenoma detection rate (ADR) and polyp detection rate (PDR) by virtual chromoendoscopy. Aim of the present study was to evaluate the effectiveness of LCI in ADR and PDR compared to the HD white-light colonoscopy (WLC) technique.

Materials and methods: Between October 2016 and June 2018, we enrolled consecutive outpatients prospectively. Eligible patients allocated randomly to undergo HD WLC or LCI colonoscopy technique during instrument withdrawal. Each colonoscopy was performed in a single center by the same three expert endoscopists (with expertise more than 5000 colonoscopies).

Results: A total of 1278 patients underwent colonoscopy in the study period. ADR and PDR were significantly higher in the LCI group compared to the WLC group (34.4% vs. 26.8%; p = .007; and 53.3% vs 46.4%; p = .023, respectively). Similarly, the mean number of adenomas per patient (MAP) was significantly higher with the LCI than WLC (0.64 vs 0.44, respectively; p = .002). The mean age of patients at the time of colonoscopy was 51.95 years (SD = 13.861) in the LCI group and 51.96 years (SD = 14.028) in the WLC group. No significant differences observed in patient demographic characteristics (there was no difference in gender and age distribution, p = .986), quality of colonoscopy preparation and withdrawal times (WT) between the two groups (WLC and the LCI groups, 493.9 (SD: 143.5) and 514.0 (SD: 139.5) sec, respectively).

Conclusions: According to our results, LCI virtual chromoendoscopic technology was superior compared to conventional HD WLC in detecting colorectal polyps and adenomas.

1 Institute of Applied Health Sciences, Semmelweis University, Budapest, Hungary
2 Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
3 Endoscopy Unit, Endo-Kapszula Health Centre, Szekesfehervar, Hungary
4 Department of Gastroenterology, OMCH Endoscopy Unit, Bacs-Kiskun County Hospital, Kecskemet, Hungary