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Differential diagnosis of Helicobacter pylori-associated gastritis with the linked-color imaging score.

Jiang ZX1, Nong B1, Liang LX1, Yan YD1, Zhang G1.

Dig Liver Dis. 2019 Aug 13. pii: S1590-8658(19)30682-6. doi: 10.1016/j.dld.2019.06.024. [Epub ahead of print]

Background: Helicobacter pylori (H. pylori) infection in gastric mucosa is the main risk factor for gastric cancer. The purpose of this study was to assess the value of the linked-color imaging (LCI) score for the identification of H. pylori-associated gastritis.

Methods: A total of 358 patients were enrolled in the study. H. pylori was positive in 127 cases and negative in 231 cases. Redness of fundus glands, granular erosion, purple mucus (+) and mucus lake turbidity were investigated by the LCI mode of endoscopy. Logistic regression was used to screen the observation indexes and their relative partial regression coefficients, which were helpful for the differential diagnosis of H. pylori infection. Then, each observation index was scored according to the partial regression coefficient.

Results: Using a total scores of 3.5 as the cut-off value, the sensitivity and specificity were 83.8% and 99.5%, respectively, for the differential diagnosis of H. pylori gastritis. The area under the curve was 95.3%.

Conclusions: The LCI score showed high sensitivity and specificity for the differential diagnosis of H. pylori-associated gastritis and is an effective method for identifying H. pylori infection in gastric mucosa.

1 Department of Digestion, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China

Accuracies of Endoscopic Diagnosis of Helicobacter pylori-Gastritis: Multicenter Prospective Study Using White Light Imaging and Linked Color Imaging.

Ono S1, Dohi O2, Yagi N3, Sanomura Y4, Tanaka S5, Naito Y2, Sakamoto N6, Kato M7

Digestion. 2019 Jul 23:1-7. doi: 10.1159/000501634. [Epub ahead of print]

Introduction: The diagnosis of Helicobacter pylori infection status with white light imaging (WLI) is difficult. We evaluated the accuracies of using WLI and linked color imaging (LCI) for diagnosing H. pylori-active gastritis in a multicenter prospective study setting.

Methods: Patients who underwent esophagogastroduodenoscopy were prospectively included. The image collection process was randomized and anonymous, and the image set included 4 images with WLI or 4 images with LCI in the corpus that 5 reviewers separately evaluated. Active gastritis was defined as positive when there was diffuse redness in WLI and crimson coloring in LCI. The H. pylori infection status was determined by the urea breath test and the serum antibody test. Cases in which both test results were negative but atrophy or intestinal metaplasia was histologically confirmed were defined as past infections. The primary endpoint was the diagnostic accuracies of WLI and LCI, and the secondary endpoint was inter-observer agreement.

Results: Data for 127 patients were analyzed. The endoscopic diagnostic accuracy for active gastritis was 79.5 (sensitivity of 84.4 and specificity of 74.6) with WLI and 86.6 (sensitivity of 84.4 and specificity of 88.9) with LCI (p = 0.029). LCI significantly improved the accuracy in patients with past infections over WLI (36.8 in WLI and 78.9 in LCI, p < 0.01). The κ values were 0.59 in WLI and 0.70 in LCI.

Conclusions: LCI is useful for endoscopic diagnosis of H. pylori-active or inactive gastritis, and it is advantageous for patients with past infections of inactive gastritis.

1 Department of Gastroenterology, Hokkaido University Hospital, Sapporo, Japan
2 Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
3 Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
4 Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
5 Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
6 Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
7 Department of Gastroenterology, National Hospital Organization Hakodate Hospital, Hakodate, Japan

Diagnostic utility of linked color imaging in the evaluation of colonic mucosal inflammation in ulcerative colitis: a pilot study.

Kanmura S1, Hamamoto H1, Tanaka A1, Arima S1, Sasaki F1, Tanoue S1, Nasu Y1, Hashimoto S1, Higashi M2, Ido A1.

Endosc Int Open. 2019 Aug;7(8):E937-E943. doi: 10.1055/a-0810-0398. Epub 2019 Jul 24.

Background and aims: Recent studies recommend histological mucosal healing of intestinal tissue as a treatment goal in ulcerative colitis (UC). Linked-color imaging (LCI) is a new endoscopy system that enhances the color differences of the gastrointestinal mucosa. We investigated the efficacy of LCI in the evaluation of intestinal activity, including the histological activity in UC.

Method: A total of 21 UC patients who were evaluated by the LASEREO system (FUJIFILM Co., Tokyo, Japan) were enrolled from August to December in 2016. All of the target points were observed by conventional white-light imaging (WLI) and LCI and biopsied from the region of interest in each view. We quantified the color tones of 73 biopsied points on WLI and LCI using the Lab* color value (WLI-L, WLI-a, WLI-b, and LCI-L, LCI-a, LCI-b). We then investigated the relationships among the Lab* color values, endoscopic findings, and histological healing.

Results: The average LCI-a and LCI-b values of patients with high mucosal activity disease were significantly higher than in those with mucosal healing ( P  < 0.01), and only LCI-a was significantly correlated with the score for histological healing. With regard to the other color values (LCI-L and all WLI values), there were no statistically significant differences in terms of average color value and correlation between patients with high mucosal activity and those with mucosal healing. In addition, the difference in the average color values with LCI and WLI was 7.1 and 3.1, respectively.

Conclusion: LCI is more useful than WLI for the visualization and evaluation of mucosal inflammation in UC.

1 Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
2 Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

Blue Light Imaging and Linked Color Imaging for the Characterization of Mucosal Changes in Chronic Gastritis: A Clinicians View and Brief Technical Report.

Weigt J1, Malfertheiner P1, Canbay A1, Haybaeck J2, Bird-Lieberman E3, Link A2.

Dig Dis. 2019 Jul 23:1-6. doi: 10.1159/000501265. [Epub ahead of print]

Background: Blue light imaging (BLI) and linked color imaging (LCI) are new imaging modalities for the endoscopic evaluation of mucosal changes within the digestive tract. There is little experience with these modalities in the characterization of chronic gastritis (CG) intestinal metaplasia (IM) and atrophy in the stomach.

Aims and methods: In a single-center observational pilot study, we correlated endoscopic findings with histology in selected patients.

Results: Findings from 29 patients were included in the analysis. Six patients had macroscopically normal gastric mucosa at endoscopy, and this was confirmed histologically in 5 of them. At endoscopy, 15 patients had the presence of IM in the antrum predicted, and this was confirmed histologically in 11 (73%). In the corpus, we predicted the presence of IM in 14 patients, and this was confirmed in 11 (78%) at histology. Eleven patients had the endoscopic suspicion of atrophy in antrum, which was confirmed in 9 patients (82%). In total, 14 patients had endoscopic suspicion of atrophy in corpus mucosa at endoscopy, but only 10 were confirmed in histology (71%). The concordance of endoscopic classification and histology was 93% for antrum and 88% for corpus. The positive predictive value and negative predictive value for IM were 0.74 and 0.83 and for atrophy 0.63 and 0.97, respectively.

Conclusions: LCI and BLI are helpful in characterization of mucosal changes in CG. The ability to rule out premalignant conditions by endoscopy only reflects the clinical use and harbors significant clinical implications.

1 Department of Gastroenterology, Hepatology and Infectious Diseases, Magdeburg, Germany
2 Department of Pathology, Otto von Guericke University Magdeburg, Magdeburg, Germany
3 Translational Gastroenterology Unit and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK

Linked Color Imaging and the Kyoto Classification of Gastritis: Evaluation of Visibility and Inter-Rater Reliability.

Takeda T1, Asaoka D1, Nojiri S4, Nishiyama M1, Ikeda A1, Yatagai N1, Ishizuka K1, Hiromoto T1, Okubo S1, Suzuki M1, Nakajima A1, Nakatsu Y2, Komori H1, Akazawa Y1, Nakagawa Y1, Izumi K1, Matsumoto K1, Ueyama H1, Sasaki H1, Shimada Y3, Matsumoto K1, Osada T2, Hojo M1, Kato M5, Nagahara A1

Digestion. 2019 Jul 12:1-10. doi: 10.1159/000501534. [Epub ahead of print]

Background & aims: To compare white light imaging (WLI) with linked color imaging (LCI) and blue LASER imaging (BLI) in endoscopic findings of Helicobacter pylori presently infected, previously infected, and uninfected gastric mucosae for visibility and inter-rater reliability.

Methods: WLI, LCI and BLI bright mode (BLI-bright) were used to obtain 1,092 endoscopic images from 261 patients according to the Kyoto Classification of Gastritis. Images were evaluated retrospectively by 10 experts and 10 trainee endoscopists and included diffuse redness, spotty redness, map-like redness, patchy redness, red streaks, intestinal metaplasia, and an atrophic border (52 cases for each finding, respectively). Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and 1 (decreased). Visibility was assessed from totaled scores. The inter-rater reliability (intraclass correlation coefficient) was also evaluated.

Results: Compared with WLI, all endoscopists reported improved visibility with LCI: 55.8% for diffuse redness; LCI: 38.5% for spotty redness; LCI: 57.7% for map-like redness; LCI: 40.4% for patchy redness; LCI: 53.8% for red streaks; LCI: 42.3% and BLI-bright: 80.8% for intestinal metaplasia; LCI: 46.2% for an atrophic border. For all endoscopists, the inter-rater reliabilities of LCI compared to WLI were 0.73-0.87.

Conclusion: The visibility of each endoscopic finding was improved by LCI while that of intestinal metaplasia was improved by BLI-bright.

1 Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
2 Department of Gastroenterology, Juntendo University Urayasu Hospital, Chiba, Japan
3 Department of Gastroenterology, Juntendo Sizuoka Hospital, Shizuoka, Japan
4 Department of Medical Technology Innovation Center Juntendo University School of Medicine, Tokyo, Japan
5 Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan

Impact of linked-color imaging on colorectal adenoma detection.

Dos Santos CEO1, Malaman D1, Pereira-Lima JC2, de Quadros Onófrio F2, Ribas Filho JM3.

Gastrointest Endosc. 2019 Jul 11. pii: S0016-5107(19)32052-8. doi: 10.1016/j.gie.2019.06.045. [Epub ahead of print]

Background and aims: Linked-color imaging (LCI) is a new technology that emphasizes changes in mucosal color by providing clearer and brighter images, thus allowing red and white areas to be more clearly visualized. We investigated whether LCI increases the detection of colorectal adenomas when compared with white-light imaging (WLI) and blue-laser imaging (BLI)-bright.

Methods: Consecutive patients undergoing colonoscopy were randomized (1:1:1) into examination by WLI, BLI-bright, or LCI during withdrawal of the colonoscope. The adenoma detection rate (ADR), mean number of adenomas per patient, and withdrawal time were evaluated. The lesions were evaluated according to size, morphology, location, and histology.

Results: A total of 379 patients were randomized, and 412 adenomas were detected. ADR was 43.2%, 54.0%, and 56.9% for WLI, BLI-bright, and LCI, respectively, being significantly higher in the LCI group than in the WLI group (P=0.03). No significant difference was observed between LCI and BLI-bright (P=0.71) or BLI-bright and WLI (P=0.09). The mean number of adenomas per patient was 0.82, 1.06, and 1.38 for WLI, BLI-bright, and LCI, respectively, with a significant difference between LCI and WLI (P=0.03). Withdrawal time did not differ between groups. A total of 102 adenomas were detected by WLI, 131 by BLI-bright, and 179 by LCI. LCI provided a higher rate of detection of adenomas ≤ 5 mm in size than WLI (P=0.02), with a borderline significance for a higher detection of sessile serrated adenomas (P=0.05). Nonpolypoid adenomas were more commonly located in the right colon segment and polypoid adenomas in the left colon segment, with a significant difference only between BLI-bright (P<0.01) and LCI (P=0.03).

Conclusions: Our findings show that LCI increases the detection of colorectal adenomas during colonoscopy.

1 Department of Endoscopy and Gastroenterology, Santa Casa de Caridade Hospital, Bagé, RS, Brazil.
2 Department of Gastroenterology and Endoscopy, Santa Casa Hospital, Porto Alegre, RS, Brazil.
3 Postgraduate Program in Principles of Surgery, Faculdade Evangélica do Paraná, Curitiba, PR, Brazil.