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Linked color imaging improves detection of minimal change esophagitis in non-erosive reflux esophagitis patients.

Deng P1, Min M1, Dong T1, Bi Y1, Tang A1, Liu Y1

Endosc Int Open. 2018 Oct;6(10):E1177-E1183. doi: 10.1055/a-0602-3997. Epub 2018 Oct 8.

Background and study aims: Non-erosive reflux disease (NERD) includes minimal change esophagitis (MCE) and no endoscopic abnormalities. However, for most endoscopists, it is difficult to detect MCE with conventional white-light endoscopy (WLE). Linked color imaging (LCI) technology is the most recently developed image-enhancing technology and improves detection and differentiation of subtle mucosal changes using a color contrast method. This study assessed the efficacy of WLE combined with LCI for diagnosing MCE compared with WLE.

Patients and methods: Between February and May 2017, 44 NERD patients and 40 healthy subjects were enrolled in our study. First, the distal esophagus was examined using WLE followed by LCI. Second, three experienced endoscopists observed all the patients’ white-light (WL) images and corresponding images of WL and LCI and then recorded presence or absence of minimal change esophagitis (MCE +/-). The proportion of minimal change between the two groups was then compared. Third, five blinded endoscopists with different levels of endoscopic experience assessed whether MCE was present. Intraobserver reproducibility and interobserver agreement were described using the kappa value.

Results: The proportion of MCE in the NERD group (70.8 %, 35/48) was higher than that in the control group (22.5 %, 9/40, P  < 0.001) when diagnosed by the three experienced endoscopists. Detection rates for MCE using WLE combined with LCI were higher than those using WLE (43/88, 48.9 % vs. 29/88, 33.0 %, P  < 0.001). With WLE combined with LCI, intraobserver reproducibility significantly improved, indicating that the combined approach can improve interobserver agreement compared with using WLE alone.

Conclusions:  Endoscopic diagnosis of MCE using WLE combined with LCI images is effective. Intraobserver reproducibility and interobserver agreement in MCE can be improved when LCI is applied with conventional imaging.

1 Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China

Blue laser imaging: a new image-enhanced endoscopy for the diagnosis of colorectal lesions.

Dos Santos CEO1, Malaman D1, Yoshida N2, Pereira-Lima JC3, Onófrio FQ3, Furlan RG1, Tabushi FI4, Malafaia O4 .

Eur J Gastroenterol Hepatol. 2018 Oct 2. doi: 10.1097/MEG.0000000000001278. [Epub ahead of print]

Background: Image-enhanced endoscopy enables real-time differential diagnosis of colorectal lesions through the observation of microvascular architecture.

Purpose: To evaluate the efficacy of using blue laser imaging (BLI) for capillary pattern analysis in the differential diagnosis of neoplastic and non-neoplastic lesions.

Patients and methods: This prospective study included 920 consecutive superficial lesions diagnosed in 457 patients. The capillary pattern was analysed using BLI-bright magnification on the basis of the Teixeira classification. Histopathology was used as the reference standard.

Results: The adenoma detection rate was 42.3%, with a mean of 0.95 adenomas per patient. Neoplastic lesions were predominant (70.3%), of which 33 (5.1%) had advanced histology. Neoplastic progression was significantly increased in patients aged at least 50 years, in lesions at least 10 mm and in lesions located in the right colon (P<0.01). BLI-based capillary pattern analysis showed 95.5% accuracy, 95.7% sensitivity, 95.2% specificity, 97.9% positive predictive value and 90.3% negative predictive value in the diagnosis of neoplastic lesions. For 672 diminutive lesions (≤5 mm), BLI-based capillary pattern analysis showed 95.7% accuracy, 96.6% sensitivity, 93.6% specificity, 97.2% positive predictive value and 92.2% negative predictive value. Analysing only lesions up to 5 mm in the rectum and sigmoid colon, the values were 95.2, 93.9, 96.5, 95.8 and 94.8%, respectively.

Conclusion: BLI associated with magnification yielded excellent results for the real-time predictive histological diagnosis of colorectal lesions.

1 Department of Endoscopy and Gastroenterology, Santa Casa de Caridade hospital, Bagé
2 Department of Gastroenterology and Endoscopy, Santa Casa Hospital, Porto Alegre
3 department of Surgery, Faculdade Evangélica do Paraná, Curitiba, Brazil
4 Department of Molecular Gastroenterology and Hepatology, Graduate School of Mecdical Science, Koyo Prefectural University of Medicine, Kyoto, Japan

Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia.

Fukuda H1, Miura Y1, Osawa H2, Takezawa T1, Ino Y1, Okada M1, Khurelbaatar T1, Lefor AK1, Yamamoto H1.

J Gastroenterol. 2018 Oct 5. doi: 10.1007/s00535-018-1515-6. [Epub ahead of print]

Background: Linked color imaging (LCI) increases the visibility of early gastric cancers, which may be associated with characteristic findings including background purple mucosae. These lesions are found in areas of chronic gastritis and surrounding mucosa. The aim of this study is to objectively characterize these lesions by color differences and color component values using LCI.

Methods: Fifty-two patients with early gastric cancer were enrolled. Color differences were calculated prospectively in malignant lesions and adjacent mucosa and compared with histological findings in resected specimens. Color component values of L, a, and b* were compared between purple and non-purple mucosae in areas of chronic gastritis. Based on histological findings, the accuracy of identifying gastric intestinal metaplasia was calculated.

Results: Cancers and surrounding mucosa in 74% of lesions had similar colors using white light imaging (WLI), whereas purple mucosa surrounded part or all of cancers appearing orange-red, orange or orange-white using LCI. Greater color differences were seen using LCI compared to WLI, including flat-type cancers, leading to higher contrast. The surrounding purple mucosa corresponded histologically to intestinal metaplasia, facilitating the identification of malignant lesions. Forty lesions (83%) with purple mucosa and eight lesions (17%) with non-purple mucosa in areas of chronic gastritis were diagnosed as intestinal metaplasia by biopsy (83% accuracy). Color component values of purple mucosa differ significantly from those of non-purple mucosae.

Conclusions: LCI images have higher color contrast between early gastric cancers and surrounding mucosa compared to WLI. A characteristic purple color around gastric cancers using LCI represents intestinal metaplasia.

1 Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
2 Department of Surgery, Jichi Medical University, Shimotsuke, Japan

Blue-light imaging compared with high-definition white light for real-time histology prediction of subcentimetric colorectal polyps: a prospective randomized study.

Rondonotti E1, Paggi S1, Amato A1, Mogavero G1,2, Andrealli A1, Conforti FS1,3, Conte D1, Spinzi G1, Radaelli F1.

Gastrointest Endosc. 2018 Sep 28. pii: S0016-5107(18)33137-7. doi: 10.1016/j.gie.2018.09.027. [Epub ahead of print]

Background and aims: Blue light imaging (BLI) is a new chromoendoscopy technology, potentially useful for differentiating neoplastic from non-neoplastic lesions. Present study was aimed at comparing BLI with high-definition white light (HDWL) in the real-time histology prediction of subcentimetric (<10 mm) colonic polyps.

Methods: Consecutive outpatients undergoing colonoscopy with ELUXEO 7000 endoscopy platform and 760 series videocolonscopes (Fujifilm Co, Tokyo, Japan) having at least one polyp <10 mm, were randomized to BLI or HDWL for polyp characterization. The accuracy of high-confidence real-time histology prediction (adenoma vs. non-adenoma) by either BLI or HDWL for subcentrimentic (primary end-point) and diminutive (<5mm) polyps was calculated, along with sensitivity, specificity, positive and negative predictive values, with histopathology as the reference standard.

Results: A total of 483 polyps were detected in 245 randomized patients (125 and 120 in the BLI and HDWL arms, respectively); 358 were diminutive and 283 adenomas. Overall, 222 (85.7%) and 193 (86.1%) polyps were characterized with high-confidence by BLI and HDWL, respectively (p=0.887), with an overall accuracy of 92% and 84%, respectively (p=0.011). The accuracy was significantly higher by BLI than HDWL also for diminutive polyps (92% vs. 83%; p=0.008). When BLI was used, the negative predictive value for diminutive rectosigmoid polyps was 88% and the post-polypectomy surveillance interval was correctly attributed in 85.7% and 93.7% of patients, according to U.S. and European guidelines respectively.

Conclusions: The BLI was superior to HDWL for the real-time prediction of subcentimetric polyp histology. A BLI-dedicated classification might further improve the endoscopists’ performances.

1 Gastroenterology Unit, Valduce Hospital, Como, Italy.
2 Gastroenterology Unit, Biomedical Department of Internal and Specialized Medicine (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy.
3 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

Diffuse redness in linked color imaging is useful for diagnosing current Helicobacter pylori infection in the stomach.

Masaya Iwamuro 2, Hiroyuki Sakae 1, Hiromitsu Kanzaki 1, PhD Hiroyuki Okada 2

Journal of General and Family Medicine

Abstract: Esophagogastroduodenoscopic examination shows diffuse redness of the mucosa of the gastric body, which can be identified as a deep reddish color. The present case underscores the importance of diffuse redness as a key endoscopic feature that enables prompt diagnosis of current Helicobacter pylori infection.

1 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry
2 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

Blue laser imaging with acetic acid enhancement improved the detection rate of gastric intestinal metaplasia.

Chen H1, Wu X2, Liu Y1, Wu Q1, Lu Y1, Li C1.

Lasers Med Sci. 2018 Sep 6. doi: 10.1007/s10103-018-2629-z. [Epub ahead of print]

Abstract: Our aim was to evaluate the ability of blue laser imaging (BLI) combined with acetic acid (BLI-AA) to detect gastric intestinal metaplasia (GIM). Participants undergoing gastroscopy from July 2017 to February 2018 in our hospital were enrolled prospectively. The abilities of white light imaging endoscopy, BLI endoscopy, and BLI-AA to detect GIM were compared. One hundred six patients undergoing gastroscopy met the inclusion criteria. GIM was diagnosed in 41 patients. For BLI-AA, the sensitivity, specificity, positive predictive, and negative predictive values were 85.4%, 84.6%, 77.8%, and 90.2% respectively. The diagnostic accuracy rate for BLI-AA was 84.9%, which was higher than that of white light imaging endoscopy and BLI endoscopy. For target biopsy, the GIM detection rate for the BLI-AA mode was significantly higher (77.8%, 105/135) than that for the BLI mode (58.3%, 84/144) or the white light endoscopy mode (40.4%, 57/141) (p < 0.05). BLI-AA is an efficient and simple method for the detection of GIM.

1 Department of Gastrointestinal Endoscopy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, No.26 Yuancun Er Heng Rd, Tianhe District, Guangzhou 510655, Guangdong Province. People´s Republic of China
2 Department of Gastrointestinal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, No.26 Yuancun Er Heng Rd, Tianhe District, Guangzhou 510655,
Guangdong Province. People´s Republic of China