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Diagnostic ability of blue laser imaging combined with magnifying endoscopy for early esophageal cancer.

Diao W1, Huang X1, Shen L1, Zeng Z2.

Dig Liver Dis. 2018 Mar 30. pii: S1590-8658(18)30668-6. doi: 10.1016/j.dld.2018.03.027. [Epub ahead of print]

Background: Blue laser imaging (BLI) is a new image-enhanced endoscopy technique that utilizes a laser light source developed for narrow-band light observation.

Aims: To evaluate the value of BLI combined with magnifying endoscopy (M-BLI) for the diagnosis of early esophageal cancers (EECs).

Methods: This single-center prospective study analyzed 149 patients with focal esophageal lesions detected with white light endoscopy (WLE) at Renmin Hospital of Wuhan University between April 2015 and June 2017. In this study, patients were examined sequentially with narrow-band imaging combined with magnifying endoscopy (M-NBI), M-BLI and 1.25% Lugol’s iodine chromoendoscopy. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated using the agreement (kappa) test. The paired chi-square test was used to compare the concordance of M-NBI, M-BLI and Lugol’s iodine chromoendoscopy.

Results: This study analyzed 153 lesions (four patients had two lesions each). The sensitivity, specificity, accuracy, concordance rates and kappa value of M-BLI were 95.2%, 91.9%, 85.7%, 92.8% and 0.891, respectively; those of M-NBI were 95.2%, 92.8%, 87.5%, 93.5% and 0.906; and those of Lugol’s iodine chromoendoscopy were 95.2%, 94.6%, 91.3%, 94.8% and 0.936.

Conclusion: M-BLI has a diagnostic profile similar to that of M-NBI and could improve the accuracy of EEC diagnosis.

1 Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
2 Department of Pathology, Renmin Hospital of Wuhan University. Wuhan, China

Classification of atrophic mucosal patterns on Blue LASER Imaging for endoscopic diagnosis of Helicobacter pylori-related gastritis: A retrospective, observational study.

Nishikawa Y1, Ikeda Y2, Murakami H3, Hori SI4, Hino K4, Sasaki C3, Nishikawa M4.

PLoS One. 2018 Mar 29;13(3):e0193197. doi: 10.1371/journal.pone.0193197. eCollection 2018.

Background: Atrophic gastritis can be classified according to characteristic mucosal patterns observed by Blue LASER Imaging (BLI) in a medium-range to distant view.

Aims: To facilitate the endoscopic diagnosis of Helicobacter pylori (HP)-related gastritis, we investigated whether atrophic mucosal patterns correlated with HP infection based on the image interpretations of three endoscopists blinded to clinical features.

Methods: This study included 441 patients diagnosed as having atrophic gastritis by upper gastrointestinal endoscopy at Nishikawa Gastrointestinal Clinic between April 1, 2015 and March 31, 2016. The presence/absence of HP infection was not taken into consideration. Endoscopy was performed using a Fujifilm EG-L580NW scope. Atrophic mucosal patterns observed by BLI were classified into Spotty, Cracked and Mottled. Image interpretation results were that 89, 122 and 228 patients had the Spotty, Cracked and Mottled patterns, respectively, and 2 patients an undetermined pattern. Further analyses were performed on 439 patients, excluding the 2 with undetermined patterns.

Results: The numbers of patients testing negative/positive for HP infection in the Spotty, Cracked and Mottled pattern groups were 12/77, 105/17, and 138/90, respectively. The specificity, positive predictive value and positive likelihood ratio for endoscopic diagnosis with positive HP infection based on the Spotty pattern were 95.3%, 86.5% and 8.9, respectively. In all patients with the Spotty pattern before HP eradication, the Cracked pattern was observed on subsequent post-eradication endoscopy.

Conclusions: The Spotty pattern may represent the presence of HP infection, the Cracked pattern, a post-inflammatory change as seen after HP eradication, and the Mottled pattern, intestinal metaplasia.

1 Nishikawa Gastrointestinal Clinic, Matsuyama, Ehime, Japan
2 Endoscopy Center, Ehime University Hospital, Toon, Ehime, Japan
3 Department of Internal Medicine, Saiseikai Matsuyama Hospital Matsuyama, Ehime, Japan
4 Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan

Linked color imaging reduces the miss rate of neoplastic lesions in the right colon: a randomized tandem colonoscopy study

Paggi S1, Mogavero G1, Amato A1, Rondonotti E1, Andrealli A1, Imperiali G1, Lenoci N1, Mandelli G1, Terreni N1, Conforti FS1, Conte D1, Spinzi G1, Radaelli F1.

Endoscopy. 2018 Apr;50(4):396-402. doi: 10.1055/a-0580-7405. Epub 2018 Mar 14.

Background:  Linked color imaging (LCI) is a newly developed image-enhancing endoscopy technology that provides bright endoscopic images and increases color contrast. We investigated whether LCI improves the detection of neoplastic lesions in the right colon when compared with high definition white-light imaging (WLI).

Methods: Consecutive patients undergoing colonoscopy were randomized (1:1) after cecal intubation into right colon inspection at first pass by LCI or by WLI. At the hepatic flexure, the scope was reintroduced to the cecum under LCI and a second right colon inspection was performed under WLI in previously LCI-scoped patients (LCI–WLI group) and vice versa (WLI–LCI group). Lesions detected on first- and second-pass examinations were used to calculate detection and miss rates, respectively. The primary outcome was the right colon adenoma miss rate.

Results: Of the 600 patients enrolled, 142 had at least one adenoma in the right colon, with similar right colon adenoma detection rates (r-ADR) in the two groups (22.7 % in LCI–WLI and 24.7 % in WLI–LCI). At per-polyp analysis, double inspection of the right colon in the LCI–WLI and WLI–LCI groups resulted in an 11.8 % and 30.6 % adenoma miss rate, respectively (P < 0.001). No significant difference in miss rate was found for advanced adenomas or sessile serrated lesions. At per-patient analysis, at least one adenoma was identified in the second pass only (incremental ADR) in 2 of 300 patients (0.7 %) in the LCI – WLI group and in 13 of 300 patients (4.3 %) in the WLI – LCI group (P = 0.01).

Conclusions: LCI could reduce the miss rate of neoplastic lesions in the right colon.

1 Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy.
# Contributed equally

Linked color imaging enhances endoscopic detection of sessile serrated adenoma/polyps

Fujimoto D1, Muguruma N1, Okamoto K1, Fujino Y1, Kagemoto K1, Okada Y1, Takaoka Y1, Mitsui Y1, Kitamura S1, Kimura T1, Miyamoto H1, Bando Y2, Sonoda T3, Takayama T1.

Endoscopy International Open 2018 Mar;6(3):E322-E334. doi: 10.1055/s-0043-124469. Epub 2018 Mar 7.

Background and study aims: Although new image-enhanced endoscopy (IEE) technologies such as blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) have been developed, their utility for the detection of sessile serrated adenoma/polyps (SSA/Ps) is still unclear. This study aimed to evaluate the utility of BLI, BLI-bright, and LCI for SSA/P detection in still image examinations and in a prospective randomized controlled trial (RCT).

Patients and methods: A group of 6 expert and non-expert endoscopists read 200 endoscopic still images containing SSA/P lesions using white light image (WLI), BLI, BLI-bright, and LCI. Color differences were calculated using the color space method. A prospective RCT of tandem colonoscopy with WLI and LCI was performed. Patients with SSA/P and those with a history of SSA/P that had been endoscopically removed were enrolled and randomly allocated to WLI-LCI or LCI-WLI groups. Additional endoscopic detection rates for SSA/P were compared between the 2 groups.

Results: LCI showed the highest SSA/P detection rate among the 4 modes for both expert and non-expert endoscopists. The detection rate with LCI for the 6 expert endoscopists (mean 98.3 ± standard deviation 2.0 %) was significantly higher than that with WLI (86.7 ± 6.0 %, P < 0.01). Likewise, the detection rate with LCI for the 6 non-expert endoscopists (92.3 ± 2.9 %) was significantly higher than that with WLI (72.7 ± 11.5 %, P < 0.01). The color difference of SSA/P with LCI was the highest among the 4 modes, and was significantly higher than with WLI (median 15.9, (interquartile range 13.7 – 20.6) vs. 10.2, (7.6 – 14.2); P < 0.0001). In the RCT, a total of 44 patients (WLI-LCI 22 vs. LCI-WLI 22) underwent colonoscopy. The additional detection rate for SSA/P in the second inspection in the WLI-LCI group (21.6 %, 8/37) was significantly higher than in the LCI-WLI group (3.2 %, 1/31; P = 0.02). The small, flat, non-mucus and isochromatic SSA/Ps in the transverse colon were detected more frequently in the second inspection with LCI.

Conclusions: LCI was the most sensitive mode for SSA/P detection among WLI, BLI, BLI-bright, and LCI in the still image examinations. Our RCT strongly suggests that LCI is superior to conventional WLI for SSA/P detection during colonoscopy. UMIN000017599.

1 Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
2 Division of Pathology, Tokushima University Hospital, Tokushima, Japan.
3 Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.

Improved Visibility of Barrett’s Esophagus with Linked Color Imaging: Inter- and Intra-Rater Reliability and Quantitative Analysis.

Takeda T1, Nagahara A2, Ishizuka K1, Okubo S1, Haga K1, Suzuki M1, Nakajima A1, Komori H1, Akazawa Y1, Izumi K1, Matsumoto K1, Ueyama H1, Shimada Y1, Matsumoto K1, Asaoka D1, Shibuya T1, Sakamoto N1, Osada T1, Hojo M1, Nojiri S3, Watanabe S1.

Digestion. 2018 Jan 10;97(2):183-194. doi: 10.1159/000485459. [Epub ahead of print]

Background/Aims: To evaluate the usefulness of linked color imaging (LCI) and blue LASER imaging (BLI) in Barrett’s esophagus (BE) compared with white light imaging (WLI).

Methods: Five expert and trainee endoscopists compared WLI, LCI, and BLI images obtained from 63 patients with short-segment BE. Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and one (decreased). Scores were evaluated to assess visibility. The inter- and intra-rater reliability (intra-class correlation coefficient) of image assessments were also evaluated. Images were objectively evaluated based on L* a* b* color values and color differences (ΔE*) in a CIELAB color space system.

Results: Improved visibility compared with WLI was achieved for LCI: 44.4%, BLI: 0% for all endoscopists; LCI: 55.6%, BLI: 1.6% for trainees; and LCI: 47.6%, BLI: 0% for experts. The visibility score of trainees compared with experts was significantly higher for LCI (p = 0.02). Intra- and inter-rater reliability ratings for LCI compared with WLI were “moderate” for trainees, and “moderate-substantial” for experts. The ΔE* revealed statistically significant differences between WLI and LCI.

Conclusion: LCI improved the visibility of short-segment BE compared with WLI, especially for trainees, when evaluated both subjectively and objectively.

1 Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
2 Department of Gastroenterology, Juntendo Sizuoka Hospital, Sizuoka, Japan.
3 Department of Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo, Japan.

Objective Endoscopic Analysis with Linked Color Imaging regarding Gastric Mucosal Atrophy: A Pilot Study.

Mizukami K1, Ogawa R1, Okamoto K1, Shuto M1, Fukuda K1, Sonoda A1, Matsunari O1, Hirashita Y1, Okimoto T1, Kodama M1, Murakami K1.

Gastroenterol Res Pract. 2017; 2017:5054237. Epub 2017 Nov 15.

Objectives: We aimed to determine whether linked color imaging (LCI), a new image-enhanced endoscopy that enhances subtle differences in mucosal colors, can distinguish the border of endoscopic mucosal atrophy.

Methods: This study included 30 patients with atrophic gastritis. In endoscopy, we continuously took images in the same composition with both LCI and white light imaging (WLI). In each image, the color values of atrophic and nonatrophic mucosae were quantified using the International Commission on Illumination 1976 (L∗, a∗, b∗) color space. Color differences at the atrophic border, defined as Euclidean distances of color values between the atrophic and nonatrophic mucosae, were compared between WLI and LCI for the overall cohort and separately for patients with Helicobacter pylori infection status.

Results: We found that the color difference became significantly higher with LCI than with WLI in the overall samples of 90 points in 30 patients. LCI was 14.79 ± 6.68, and WLI was 11.06 ± 5.44 (P < 0.00001). LCI was also more effective in both of the Helicobacter pylori-infected group (P = 0.00003) and the Helicobacter pylori-eradicated group (P = 0.00002).

Conclusions: LCI allows clear endoscopic visualization of the atrophic border under various conditions of gastritis, regardless of Helicobacter pylori infection status.

1 Department of Gastroenterology, Oita University, Japan.