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Comparison of Linked color imaging and white-light colonoscopy for colorectal polyp detection: a multicenter, randomized, crossover trial.

Min M1, Deng P1 etc

Gastrointest Endosc. 2017 Mar 9. Impact factor 5.369

Background and Aims: Linked color imaging (LCI) is a recently developed technology that uses a laser endoscopic system to enhance the color separation of red color to depict red and white colors more vividly. The benefits of LCI in colorectal polyp detection remain unknown. The aim of this study was to assess the ability of LCI to increase colorectal polyp detection compared to white-light (WL) endoscopy.

Methods: We performed a multicenter, crossover, prospective, randomized controlled trial in three hospitals in China. All patients underwent crossover colonoscopies with LCI and WL endoscopy in a randomized order. All lesions were removed during the second endoscopic procedure. The primary outcome measure was the difference in sensitivity between LCI and WL endoscopy for the detection of colorectal polyps. The secondary outcome measures were the adenoma detection rate per patient in the two groups and the factors associated with polyp miss rates.

Results: A total of152 patients were randomized, and 141 were included in the analysis. The overall polyp detection rate increased significantly by 24% for LCI colonoscopy, corresponding to a higher sensitivity of LCI than WL endoscopy (91% vs 73%, P<0.0001). Furthermore, LCI identified significantly more patients (32%) with polyps. The per-patient adenoma detection rate was significantly higher for LCI than WL endoscopy (37% vs 28%, 95% CI, 2.39% – 19.41%).

Conclusion: LCI improves the detection of colorectal polyps and adenomas during colonoscopy.

Linked color imaging enhances gastric cancer in gastric intestinal metaplasia.

Ono S, Abiko S, Kato M. etc

Dig Endosc. 2017 Mar;29(2) Impact factor 2.715

Gastric intestinal metaplasia (GIM) is a high-risk condition for intestinal-type gastric cancer; however, there is a limitation for detection of GIMusing white light imaging (WLI). Image-enhanced endoscopy (IEE) is more advantageous than WLI for optical diagnosis of GIM.1 Linked colorimaging (LCI; FUJIFILM Co., Tokyo, Japan) was newly developed for advanced IEE and enables visualization of red lesions that appear redder and whitish red lesions that appear whiter during routine endoscopy.2 GIM is observed as a lavender color that is distinguishable from the circumferential mucosa without GIM by using LCI (Fig. 1). We speculate that the lavender color is the same as the bluish–whitish patchy areas including a light blue crest or a marginal turbid band in narrow band imaging.3,4 In contrast, gastric cancer is observed as lesions of various degrees of redness depending on the quantity of blood vessels.

Awoman in her 70s received screening esophagogastroduodenoscopy in the 7th year after Helicobacter pylori eradication. At first, neither abnormal lesions nor GIM were detected in the antrum by WLI, but a 10mm slightly reddish depressed lesion in a lavender color area was observed by LCI (Fig. 2a,b). A biopsy specimen from this lesion revealed well-differentiated tubular adenocarcinoma, and endoscopic submucosal dissection (ESD) was therefore carried out. Histologically, GIM surrounded the intramucosal adenocarcinoma (Fig. 2c,d).

The present case showed an important advantage of LCI during routine endoscopy. GIM, which is a high-risk condition for gastric cancer, was easily detected by LCI as a lavender color. Furthermore, LCI enhanced a gastric cancer in GIM. LCI would be a useful tool for detection of gastric cancer in high-risk patients.

Assessment of endoscopic mucosal healing of ulcerative colitis using linked colour imaging, a novel endoscopic enhancement system

Uchiyama K1, Takagi T1, etc.

J Crohns Colitis. 2017 Feb 22 Impact factor 6.585

Background and Aims: Mucosal healing and control of intestinal mucosal inflammation are important treatment goals for maintaining clinical remission in ulcerative colitis (UC) patients. Here, we investigated the efficacy of LCI, a novel endoscopic enhancement system, to diagnose mucosal inflammation in UC patients.

Methods: All examinations were carried out with a LASEREO endoscopic system (FUJIFILM Co., Tokyo, Japan). Fifty-two patients with UC were enrolled, and 193 areas assessed by LCI were examined. LCI patterns were classified as A, no redness; B, redness with visible vessels; and C, redness without visible vessels. ROI were set at biopsy sites, and red colour in the ROI was calculated as Commission internationale de l’éclairage (CIE) color space and digitized (LCI-index). Biopsy specimens were taken at each ROI and evaluated with Matts histopathological grade. Thirty months was defined as the time interval between endoscopic diagnosis and relapse of UC.

Results: Inter-observer agreement for LCI classification was excellent between an expert and non-experts. Among areas with a Mayo endoscopic subscore of 0, 41.8% and 4.6% were classified as LCI-B and C respectively. Among areas with Mayo endoscopic subscore of 1, 60.5% and 34.6% were classified as LCI-C, and B respectively. LCI-index strongly correlated with histopathological Matts score. Non-relapse rates significantly correlated with LCI classification (p=0.0055), but not with Mayo endoscopic subscore (p=0.0632).

Conclusions:Endoscopic LCI classification and LCI index can subdivide samples with the same Mayo endoscopic subscore. LCI may be a novel approach to evaluate colonic mucosal inflammation and predict outcome in UC patients.

Linked-color imaging improves endoscopic visibility of colorectal nongranular flat lesions.

Suzuki T, Hara T etc

Gastrointest Endosc. 2017 Feb 10. pii: S0016-5107(17)30088-3. Impact factor 5.369

Background and Aims: As a newly developed image-enhanced endoscopy (IEE) technique, linked-color imaging (LCI) provides very bright images with enhanced color tones. With the objective of improving the detection rate of colorectal flat tumor lesions, which are difficult to detect, we examined the usefulness of LCI from the viewpoint of visibility.

Methods: Fifty-three consecutive nongranular flat tumors were used in this study. Endoscopic images were acquired by white-light imaging (WLI), blue-laser imaging (BLI)-bright, and LCI modes. For each lesion, we selected one image each acquired by WLI, BLI-bright, and LCI modes. Six endoscopists interpreted the images. Using a previously reported visibility scale, we scored the visibility level on a scale of 1 to 4.

Results: The mean visibility scores were 2.74 ± 1.08 for WLI, 2.94 ± 0.97 for BLI-bright, and 3.36 ± 0.72 for LCI. The score was significantly higher for BLI-bright compared with WLI (p<0.001), and again higher for LCI compared with BLI-bright (p<0.001). When comparing between experts and trainees, the corresponding scores of experts were 2.83 ± 1.06, 3.17 ± 0.88, and 3.40 ± 0.74, with a tendency similar to the scores of all endoscopists. For the trainees, there was no difference between the scores for WLI (2.65 ± 1.10) and BLI-bright (2.71 ± 1.00), but the score for LCI (3.31 ± 0.69) was significantly higher than that for WLI or BLI-bright (p<0.001). When only sessile serrated adenoma/polyp (SSA/P) lesions were analyzed, LCI remained significantly higher than the other two.

Conclusions: The present findings suggest that LCI increases the visibility of colorectal flat lesions and contributes to improve the detection rate of these lesions.

Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial.

Ikematsu H, Sakamoto T

Gastrointest Endosc. 2017 Jan 29. Impact factor 5.369

Background and Aims: Most studies have not reported an improvement in the detection of adenomas with the use of image-enhanced colonoscopy methods, possibly because of the darkness of the images. To overcome this limitation, a new-generation endoscopic system has been developed. This system has 2 blue-laser imaging (BLI) observation modes. The BLI observation was set to BLI-bright mode to detect lesions. We aimed to evaluate the efficacy of BLI in detecting lesions.

Methods: This study was designed as a randomized controlled trial with participants from 8 institutions. We enrolled patients aged ≥40 years. The participants were randomly assigned to 2 groups: observation by using white-light imaging (WLI) with a conventional xenon light source (WLI group) or observation by using BLI-bright mode with a laser light source (BLI group). All of the detected lesions were resected or had a biopsy taken for histopathologic analysis. The primary outcome was the mean number of adenomas per patient (MAP) that were detected per procedure.

Results: The WLI and BLI groups consisted of 474 and 489 patients, respectively. The MAP was significantly higher in the BLI group than in the WLI group (mean ± standard deviation [SD] WLI 1.01 ± 1.36, BLI 1.27 ± 1.73; P = .008). Adenoma detection rate in the BLI group was not significantly higher than in the WLI group. Observation times differed significantly, with BLI (9.48 minutes) being longer than WLI (8.42; P < .001). The mean (± SD) number of polyps per patient was significantly higher in the BLI group compared with the WLI group (WLI 1.43 ± 1.64, BLI 1.84 ± 2.09; P = .001).

Conclusions: A newly developed system that uses BLI improves the detection of adenomatous lesions compared with WLI.

Laser Imaging Facilitates Early Detection of Synchronous Adenocarcinomas in Patients with Barrett’s Esophagus.

Iwashita C, Miura Y

Clin Endosc. 2017 Jan;50(1): Impact factor 0.94

Abstract: Barrett’s adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE), blue laser imaging (BLI), and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett’s adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett’s esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett’s adenocarcinoma.