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Publications – LCI

The role of linked color imaging in endoscopic diagnosis of Helicobacter pylori associated gastritis

Sang Pyo Lee1, Jin Lee1, Sea Hyub Kae1, Hyun Joo Jang1, Dong Hee Koh1, Jang Han Jung1, Sun-Ju Byeon2

Scand J Gastroenterol. 2020 Jul 15;1-7. doi: 10.1080/00365521.2020.1794025. Online ahead of print.

Objective: Linked color imaging (LCI), a novel image-enhanced endoscopy, can make it easy to recognize differences in mucosal color. It may be helpful for diagnosing H. pylori associated gastritis and H. pylori infection status. We investigated whether LCI could improve the diagnostic accuracy of H. pylori associated gastritis.

Materials and methods: Upper endoscopy was performed for 100 patients using white light imaging (WLI) and LCI. During the exam, endoscopic video was recorded. It was then analyzed by four expert endoscopists. They reviewed these videos for endoscopic diagnosis of atrophic gastritis, metaplastic gastritis, nodular gastritis and H. pylori infection. Tissue biopsies with rapid urease test were done to confirm H. pylori infection status and intestinal metaplasia.

Results: Kappa values for the inter-observer variability among the four endoscopists were fair to moderate under WLI and fair to good under LCI. Sensitivity, specificity, positive predictive value and negative predictive value for diagnosing H. pylori infection using WLI were 32.4%, 93.3%, 85.2% and 53.6%, respectively, while those for LCI were 57.4%, 91.3%, 88.7% and 64.3%, respectively. Total diagnostic accuracies for diagnosing H. pylori infection using WLI/LCI were 70.8%/78.8%. The accuracy and sensitivity of LCI for diagnosing H. pylori infection were significantly higher than those of WLI (p < .001 for both). However, there were no significant differences in the accuracy, sensitivity or specificity for diagnosing metaplastic gastritis between LCI and WLI.

Conclusions: LCI has better diagnostic accuracy for H. pylori infection status than WLI.

1 Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
2 Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea

Benefits of Linked Color Imaging for Recognition of Early Differentiated-Type Gastric Cancer: In Comparison With Indigo Carmine Contrast Method and Blue Laser Imaging

Takeshi Yasuda1,2, Nobuaki Yagi1, Tatsushi Omatsu1, Sadanari Hayashi1, Yuki Nakahata1, Yuriko Yasuda1, Akihiro Obora1, Takao Kojima1, Yuji Naito2, Yoshito Itoh2

Surg Endosc. 2020 Jun 16. doi: 10.1007/s00464-020-07706-1. Online ahead of print.

Background and aim: Linked color imaging (LCI) is a novel endoscopy system, which enhances slight differences in mucosal color. However, whether LCI is more useful than other kinds of image-enhanced endoscopy (IEE) in recognizing early gastric cancer remains unclear. This study aimed to evaluate LCI efficacy compared with the indigo carmine contrast method (IC), and blue laser imaging-bright (BLI-brt) in early differentiated-type gastric cancer recognition.

Methods: We retrospectively analyzed early differentiated-type gastric cancer, which were examined by all four imaging techniques (white light imaging, IC, LCI, BLI-brt) at Asahi University Hospital from June 2014 to November 2018. Both subjective evaluation (using ranking score: RS) and objective evaluation (using color difference score: CDS) were adopted to quantify early differentiated-type gastric cancer recognition.

Results: During this period, 87 lesions were enrolled in this study. Both RS and CDS of LCI were significantly higher (p < 0.01) than those of IC and BLI-brt. Both RS and CDS of BLI-brt had no significant difference compared with those of IC. Subgroup analysis revealed that LCI was especially useful in post-Helicobacter pylori eradication patients and flat or depressed lesions compared with IC and BLI-brt.

Conclusions: LCI appears to be more beneficial for the recognition of early differentiated-type gastric cancer in endoscopic screenings than IC and BLI-brt from the middle to distant view.

1 Department of Gastroenterology, Asahi University Hospital, 3-23 Hashimoto, Gifu 500-8523, Japan
2 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 465 Kawaramachi–Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan

Linked Color Imaging Followed by Magnifying Blue Laser Imaging Identifies Early Gastric Cancer in Map-Like Redness After Successful Helicobacter Pylori Eradication

Osamu Dohi1, Tsugitaka Ishida1, Naohisa Yoshida1

Dig Endosc. 2020 May 28.

Linked color imaging (LCI; Fujifilm Co., Tokyo, Japan) identifies map‐like redness (MR), which indicates gastric intestinal metaplasia (GIM) histopathologically1 and helps clearly visualize minute differences by mucosal colors.2, 3 Early gastric cancer (EGC) visibility after Helicobacter pylori (HP ) eradication is greater using LCI compared with white light imaging (WLI).4 However, depressed lesions similar to EGCs were sometimes detected in MR using LCI in clinical practice. Magnifying blue laser imaging (M‐BLI) has an excellent diagnostic accuracy for EGC.5 Therefore, we recommend M‐BLI following LCI to accurately identify EGC after HP eradication in MR (Video S1).
Case 1 is a 10‐mm depressed lesion, which was detected on the lesser curvature of the upper body after successful HP eradication (Fig. 1). WLI revealed an indistinct depressed area (Fig. 1A). LCI showed a well‐demarcated orange‐colored lesion with a clear margin surrounding the lavender color area (Fig. 1B). The lesion could be diagnosed as EGC with high confidence because M‐BLI shows irregular microvessels and microstructures with a clear border. The lesion was pathologically diagnosed as a well‐differentiated intramucosal adenocarcinoma surrounding GIM. Case 2 is a 10‐mm depressed lesion, which was detected on the greater curvature of lower body after successful HP eradication. Although the lesion could not be detected using WLI (Fig. 2A), LCI detected a well‐demarcated orange‐colored lesion around the lavender color area (Fig. 2B). The lesion could be diagnosed as EGC with high confidence, because M‐BLI shows irregular microvessels and microstructures with a mostly clear border. The pathological diagnosis was a well‐differentiated intramucosal adenocarcinoma partially covered by surrounding GIM at the edge of the lesion.

1 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program

Paggi Silvia1, Radaelli Franco1, Senore Carlo2, Maselli Roberta3, Amato Arnaldo1, Andrisani Gianluca4, Di Matteo Francesco4, Cecinato Paolo5, Grillo Simone5, Sereni Giuliana5, Sassatelli Romano5, Manfredi Guido6, Alicante Saverio6, Buscarini Elisabetta6, Canova Daniele7, Milan Luisa7, Pallini Paolo7, Iwatate Mineo9, Rondonotti Emanuele1, Repici Alessandro2,8, Hassan Cesare9

Gastrointest Endosc. 2020 May14.

Background and aims: Linked-color imaging (LCI), a new image-enhancing technology emphasizing contrast in mucosal color, has been demonstrated to substantially reduce polyp miss-rate as compared with standard White-Light (WL) in tandem colonoscopy studies. Whether LCI increases adenoma detection rate (ADR) remains unclear.

Methods: Consecutive subjects undergoing screening colonoscopy after fecal immunochemical test (FIT) positivity were 1:1 randomized to undergo colonoscopy with LCI or WL, both in high-definition systems. Insertion and withdrawal phases of each colonoscopy were carried out using the same assigned light. Experienced endoscopists from 7 Italian centers participated in the study. Randomization was stratified by gender, age, and screening round. The primary outcome measure was represented by ADR.

Results: Of 704 eligible subjects, 649 (48.9% males, mean age +SD 60.8+7.3 years) were included and randomized to LCI (n=326) or WL (n=323) colonoscopy. The ADR was higher in the LCI (51.8%) than in the WL group (43.7%) (RR, 1.19; 95% CI, 1.01-1.40). The proportions of patients with advanced adenomas and sessile serrated lesions (SSL) were 21.2% and 8.6% in LCI and 18.9% and 5.9% in WL arm, respectively (p=NS for both comparisons). At multivariate analysis, LCI was independently associated with ADR, along with male gender, increasing age and adequate (Boston Bowel Preparation Scale >6) bowel preparation. At per-polyp analysis, the mean+SD number of adenomas per colonoscopy was comparable in the LCI and WL arm, whereas the corresponding figures for proximal adenomas was significantly higher in the LCI group (0.72+1.2 vs 0.55+1.07, p=0.05)

Conclusion: In FIT positive patients undergoing screening colonoscopy, the routine use of LCI significantly increases ADR. [Clinicaltrials.gov no:NCT03690297]

1 Gastroenterology Department, Valduce Hospital, Como, Italy
2 Epidemiology and screening Unit – CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
3 Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
4 Digestive Endoscopy Unit, Campus Bio-Medico, Rome, Italy.
5 Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy.
6 Gastroenterology Department, ASST Maggiore Hospital, Crema, Italy
7 Gastroenterology Unit, San Bortolo Hospital, Azienda ULSS n.8 Berica, Vicenza, Italy
8 Humanitas University, Milan, Italy
9 Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.

Usefulness of Linked Color Imaging in the Early Detection of Superficial Esophageal Squamous Cell Carcinomas

Koki Nakamura1, Yuji Urabe2, Shiro Oka3, Naoko Nagasaki3, Naoki Yorita3, Kosaku Hata3, Kazuhiko Masuda3, Mio Kurihara3, Takahiro Kotachi1, Tomoyuki Boda1, Shinji Tanaka1, Kazuaki Chayama3

Esophagus. 2020 May 23. doi: 10.1007/s10388-020-00749-2. Online ahead of print.

Background and aims: Linked color imaging (LCI) improved the visibility of gastric cancer and colorectal flat lesions. This study aimed to investigate the usefulness of LCI in detecting superficial esophageal squamous cell carcinomas (SESCC).

Methods: We enrolled 37 consecutive SESCC patients (46 SESCCs) diagnosed using LCI and blue laser imaging bright mode (BLI-BRT) and treated in Hiroshima University Hospital between April 2018 and November 2018. Eight professional endoscopists compared images obtained on non-magnifying BLI-BRT and LCI versus conventional white light imaging (WLI). Identification and boundary diagnosis of SESCC with LCI and BLI-BRT were compared with WLI. Changes in lesion visibility were clarified. Interobserver agreement was assessed. Clinicopathological features of lesion that influence visibility with LCI were assessed.

Results: In LCI, 37% (17/46) of cases had improved visibility and 63% (29/46) had unchanged visibility (interobserver agreement = 0.74). Among cases with multiple lugol voiding lesions (LVLs), ΔE between the lesion and background mucosa was significantly higher in LCI than in WLI (20.8 ± 7.9 vs 9.2 ± 6.1, P < 0.05). No significant differences were found in tumor size, morphological type, color, depth, and smoking or drinking history. However, multiple LVLs were significantly higher among cases with improved versus unchanged visibility. On BLI-BRT, 39% (18/46) of cases had improved visibility and 61% (28/46) had unchanged visibility (interobserver agreement = 0.60).

Conclusion: Almost the same as BLI-BRT, LCI improves SESCC visibility compared with WLI. This is useful for cases with multiple LVLs. In cases without background coloration (BGC), LCI may make SESCC more visible than BLI-BRT.

1 Department of Endoscopy, Hiroshima University Hospital,Hiroshima, Japan
2 Department of Regeneration and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku,Hiroshima 734-8551, Japan
3 Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan

Linked Color Imaging Can Improve Detection Rate of Early Gastric Cancer in a High-Risk Population: A Multi-Center Randomized Controlled Clinical Trial

Jie Gao 1, Xiaofeng Zhang 4, Qianqian Meng 1, Hangbin Jin 4, Zhenhua Zhu 7, Zhijie Wang 1, Wei Qian 1, Luoman Zhang 1, Yan Liu2, Min Min 2, Xing Chen3, Haihua Chen3, Shutang Han5, Jun Xiao5, Yalei Wang6, Wei Han6, Yapi Lu8, Shuntian Cai8, Weiqing Chen9, Wen Ji9, Xuhua Xiao10, Qinghua Zheng10, Beiping Zhang11, Wenbin Wu11, Guanghui Lian12, Xiaowei Liu12, Qiu Zhao13, Min Chen13, Kun Zhuang14, Wangli Si14, Xingang Shi1, Youxiang Chen7, Zhaoshen Li1, Dong Wang1,15

Dig Dis Sci. 2020 May 4

Background: Early diagnosis of gastric cancer is difficult in China due to the lack of a valid method for endoscopic screening. Early gastric cancer, especially flat gastric cancer, lacks specific endoscopic features. Many cases appear to be similar to ordinary gastritis cases under normal white light endoscopy, which can lead to misdiagnosis.

Aims: In order to find a new method to improve detection rate of early gastric cancer in China, we designed a trial to validate linked color imaging (LCI) for screening of early gastric cancer in a high-risk population, as compared to white light imaging (WLI).

Method: Subjects were randomly allocated to either the LCI + WLI or WLI group and then subjected to gastroscopy and all endoscopies were made after special preparation. All endoscopists had knowledge of this experiment. The main indicator was the rate of detection of gastric neoplastic lesions. The difference in the detection rate between the two groups is reported.

Results: The detection rate was 4.31% in the WLI group and 8.01% in the LCI + WLI group. This is a difference of 3.70% with a P value < 0.001 and an OR (95% CI) of 1.934 (1.362, 2.746). The lower limit of the 95% CI was greater than 0, and the superiority margin was 1%.

Conclusion: The detection rate of gastric neoplastic lesions was higher in the LCI + WLI group than in the WLI group, LCI might be an effective method for screening early gastric cancer.

1 Department of Gastroenterology, Changhai Hospital, The Second Military University, Shanghai, China
2 Department of Gastroenterology, The Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of the PLA), Beijing, China
3 Endoscopy Center, Shanxi Cancer Hospital, Taiyuan, China
4 Department of Gastroenterology, Afliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
5 Jiangsu Province Hospital of TCM and Afliated Hospital of Nanjing University of TCM, Nanjing, China
6 The First Afliated Hospital of Anhui Medical University, Hefei, China
7 The First Afliated Hospital of Nanchang University, Nanchang, China
8 Department of Gastroenterology, Zhongshan Hospital Afliated to Xiamen University, Xiamen, China
9 Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing
Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
10 Afliated Hospital of Guilin Medical University, Guilin, China
11 Guangdong Provincial TCM Hospital, Guangzhou, China
12 Gastroenterology Department of Xiangya Hospital, CSU, Changsha, China
13 Zhongnan Hospital of Wuhan University, Wuhan, China
14 Xi’an Central Hospital, Xi’an, China
15 Digestive Endoscopy Center, Changhai Hospital, The Second Military University, Shanghai, China