Majima A^1,2, Dohi O¹, Takayama S¹, Hirose R¹, Inoue K¹, Yoshida N¹, Kamada K¹, Uchiyama K¹, Ishikawa T¹, Takagi T¹, Handa O¹, Konishi H¹, Naito Y¹, Itoh Y¹.

Gastrointest Endosc. 2019 Jul 9. pii: S0016-5107(19)32047-4. doi: 10.1016/j.gie.2019.06.043. [Epub ahead of print]

Background & aims: Limited studies have evaluated the risk factors of gastric cancer (GC) after Helicobacter pylori eradication using endoscopic findings. We aimed to investigate GC detection-related endoscopic findings after H pylori eradication using linked color imaging (LCI), a novel image-enhanced endoscopy.

Methods: This single-center, cross-sectional study evaluated background mucosa-associated endoscopic findings described in the Kyoto classification of gastritis in patients with newly detected GC after H pylori eradication (CA group, n=109) and those without GC (NC group, n=85) using white-light imaging (WLI) and LCI.

Results: Severe atrophy and map-like redness were significantly more frequent in the CA group than in the NC group using WLI (79.8% vs 63.5%; P=0.01 and 61.5% vs 37.7%; P=0.001, respectively) and LCI (79.8% vs 63.5%; P=0.01 and 78.0% vs 45.9%; P<0.0001, respectively). Regular arrangement of collecting venules (RAC) was significantly less frequent in CA than in NC using WLI (40.3% vs 64.7%; P=0.0009) and LCI (37.6% vs 62.4%; P=0.0006). Map-like redness was an independent positive risk finding (WLI: odds ratio, 2.05; 95% CI, 1.09-3.87; P = .03; LCI: odds ratio, 3.62; 95% CI, 1.88-6.97; P<0.001), whereas RAC was an independent negative risk finding (WLI, 0.42, 0.21-0.82; P = .01; LCI, 0.46, 0.23-0.93; P=0.03) of GC detection after H pylori eradication.

Conclusions: Map-like redness, which was identified more frequently using LCI than WLI, and the absence of RAC were associated with GC detection after H pylori eradication.

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

Sun X^1,2, Bi Y¹, Nong B³, Hu D⁴, Sun X⁵, Chen H⁶, Xu Y¹, Liu Y¹.

Endosc Int Open. 2019 Jul;7(7):E885-E892. doi: 10.1055/a-0895-5377. Epub 2019 Jul 3.

Background & aims: There is a high prevalence of Helicobacter pylori infection. White light endoscopy (WLE) can be used for evaluating the mucosal lesions, but it does not have high diagnostic efficiency. Linked color imaging (LCI) is a newly developed endoscopic imaging technique. The aim of this study was to compare LCI with WLE in detecting and staging H. pylori infection in the stomach in arandomized controlled clinical trial.

Patients and methods: A total of 253 patients who had indications for gastroduodenoscopy were enrolled and randomized into Group A (n = 127), who underwent WLE followed by LCI, and Group B (n = 126), who underwent LCI followed by WLE. Clinical data were collected and the diagnostic accuracy of WLE and LCI was calculated and compared.

Results: The overall diagnostic accuracy of WLE and LCI for H. pylori infection was 31.5 % (n = 40) and 50.4 % (n = 64) in Group A (P = 0.001), and 36.5% (n = 46) and 49.2% (n = 62) in Group B (P = 0.029). In both groups, LCI had higher sensitivity, specificity, and Youden index scores than WLE. Four stages were defined in the course of H. pylori infection in the stomach. LCI staging results were more highly consistent with pathological staging than were WLE staging results (kappa value 0.772 vs. 0.516). The LCI observations were closely correlated with the pathology.

Conclusions: LCI had a higher diagnostic efficacy for H. pylori infection in the stomach. Endoscopic color features under LCI can help to stage and profile H. pylori-associated gastritis.

1 Department of Gastroenterology, the Fifth Clinical Center of Chinese PLA General Hospital (307 Hospital), Beijing, China
2 Department of Internal Medicine, Clinic of August First Film Studio, Beijing, China
3 Department of Gastroenterology and Hepatology, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
4 Department of Gastroenterology, the Second Affiliated Hospital of Soochow University, Suzhou, China
5 Department of Gastroenterology and Hepatology, Shanghai Tenth People’s Hospital, Shanghai, China
6 Department of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Kobayashi K¹, Miyahara R², Funasaka K², Furukawa K², Sawada T¹, Maeda K¹, Yamamura T¹, Ishikawa T², Ohno E², Nakamura M², Kawashima H², Nakaguro M³, Okumura Y³, Hirooka Y¹, Fujishiro M².

Dig Endosc. 2019 Jun 20. doi: 10.1111/den.13469.

Objectives: Accurate diagnosis of invasion depth is important for reliable treatment of esophageal squamous cell carcinoma, but it is limited to the muscularis mucosae to slight submucosal invasion (MM/SM1). The diagnostic accuracy of invasion depth is unsatisfactory and remains to be improved. We aimed to investigate the association between the color of the superficial esophageal squamous cell carcinoma and invasion depth using linked color imaging (LCI) under light-emitting diode (LED) light sources.

Methods: Lesions diagnosed as superficial esophageal squamous cell carcinoma were observed using white light imaging and then by LCI. The color values were calculated using Commission international de l’eclariage – Lab* color space, and the color difference was calculated according to invasion depth. The vascular diameters and vascular angles of the intrapapillary capillary loops were pathologically analyzed. Their correlation with mucosal color was also investigated by LCI.

Results: In all, 52 lesions from 48 patients were analyzed. On the basis of invasion depth, the color difference between the normal mucosa and the lesion was larger in the MM/SM1 or deeper group than in the epithelium and the lamina propria mucosa (EP/LPM) group using LCI (P = 0.025). The vascular diameter was positively correlated with the b* color value (correlation coefficient = 0.302, P = 0.033).

Conclusion: Observation using LCI under LED light sources may improve the endoscopic diagnosis of the invasion depth of superficial esophageal squamous cell carcinoma. Further research is needed to validate its usefulness. This article is protected by copyright. All rights reserved.

1 Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
2 Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
3 Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan

Taku Sakamoto¹, Kazuya Inoki¹, Hiroyuki Takamaru¹, Masau Sekiguchi¹, Masayoshi Yamada¹, Takeshi Nakajima¹, Takahisa Matsuda¹, Yutaka Saito¹

International Journal of Colorectal Disease 2019 Jun 5. doi: 10.1007/s00384-019-03323-0. [Epub ahead of print]

Purpose: Diagnosis of the depth of invasion is crucial in the endoscopic management of early colorectal cancer. Image-enhanced endoscopy (IEE) is a method for easily evaluating the depth of invasion. Linked colour imaging (LCI) is an IEE method that enables clearer identification of neoplastic lesions and mucosal inflammation. The aim of this experimental study was to explore the efficacy of LCI in vessel and pit pattern recognition when used in magnifying chromoendoscopy with crystal violet staining for superficial colorectal neoplasms.

Methods: This was an experimental study. Colour difference (CD) values between the surrounding mucosa and vessels and pits were measured on white light (WLI), blue laser (BLI), and LCI images. The CD values of 10 neoplastic lesions were calculated and compared between WLI and the other techniques.

Results: The CD value was 9.8 (interquartile range, 7.3-12.4) for WLI, 9.7 (6.7-13.4) for LCI, and 6.8 (5.1-9.3) for BLI. The CD value was statistically different between WLI and BLI but not between WLI and LCI. With regard to vessel description, the CD value was 7.5 (4.0-11.0) for WLI, 15.6 (11.6-23.9) for LCI, and 23.3 (15.8-30.4) for BLI.

Conclusions: LCI provides more diagnostic information than other light modes. Further, it is superior to the other techniques in terms of vessel visibility and is comparable to them in terms of pit recognition. These unique features of LCI may lead to its use as an alternative to WLI and BLI for pit and vessel pattern evaluation in the future.

1 Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan

Kanmura S¹, Tanaka A¹, Komaki Y¹, Ido A¹.

Digestive and Liver Disease. 2019 Apr 15. pii: S1590-8658(19)30123-9. doi: 10.1016/j.dld.2019.03.010. [Epub ahead of print]

The long-term course of ulcerative colitis (UC) is characterized by an increasing incidence of UC-associated colorectal cancer (UCAC). Although the standard method for detecting UCAC is dye-based chromoendoscopy, it has recently reported that dye-based and dye-less chromoendoscopy do not differ significantly in terms of detection of UCAC [1]. Linked-color imaging (LCI) is a new endoscopic technique that can enhance color differences in the gastrointestinal mucosa by simultaneously using white light and narrow-band, short-wavelength light.

1 Digestive and Lifestyle Diseases. Kagoshima University Graduate School of Medical and Dental Sciences, Japan