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Linked Color Imaging Demonstrates Characteristic Findings in Semi-Pedunculated Gastric Adenocarcinoma in Helicobacter Pylori-Negative Normal Mucosa

Yuji Hiraoka1, Yoshimasa Miura1, Hiroyuki Osawa1, Mio Sakaguchi2, Masato Tsunoda1, Alan Kawarai Lefor3, Hironori Yamamoto1

Clin Endosc. 2020 Aug 21. doi: 10.5946/ce.2020.059. Online ahead of print.

Linked color imaging (LCI) provides bright observation suitable for screening of the entire stomach [1], and its high color contrast to the surrounding mucosa makes it easier to detect early malignant lesions [2,3]. Compared to white light imaging, LCI enhances subtle differences in the color tone by advanced post processing steps [4]. LCI has a higher emission intensity of 410 nm, which can influence the mucosal color of various lesions [1,4]. Clear images of gastric cancer have been reported in the background with a history of Helicobacter pylori infection. Here, we report a semi-pedunculated gastric adenocarcinoma in H. pylori-negative normal mucosa imaged using LCI.

1 Division of Gastroenterology, Department of Medicine, Jichi Medical University,Tochigi, Japan
2 Department of Pathology, Jichi Medical University,Tochigi, Japan
3 Department of Surgery, Jichi Medical University,Tochigi, Japan

Linked color imaging and blue light imaging for evaluating a depressed-type adenoma in the colon

Shunsuke Yamamoto1, Nima Mottacki1

Ann Gastroenterol. Jul-Aug 2020;33(4):437. doi: 10.20524/aog.2020.0466. Epub 2020 Mar 14.

A 70-year-old man with anemia attended the hospital for colonoscopy. The examination was performed using linked color imaging (LCI) and blue light imaging (BLI) with a high-definition magnifying colonoscope (EC-760ZP-VM, Fujifilm Co.). White light imaging revealed a depressed-type polyp in the ascending colon, 8 mm in size, and was assessed as 0-IIc according to the Paris classification (Fig. 1). LCI showed an enhanced image of the depressed morphology of the polyp (Fig. 1). Magnifying BLI revealed pits smaller than those seen in surrounding normal mucosa (type IIIs in Kudo classification). No signs of invasion, such as destructed pits or vessels with varied caliber, were seen (Fig. 1). Endoscopic mucosal resection was performed. The pathological diagnosis was tubular adenoma with low-grade dysplasia, as expected from the pre-treatment observation, and it was completely resected (Fig. 2).

1 Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Improved adenoma detection with linked color imaging technology compared to white-light colonoscopy

Barbara Dorottya Lovász1,2, Milán Szalai3, László Oczella1, Ádám Finta3, Zsolt Dubravcsik4, László Madácsy3

Scand J Gastroenterol. 2020 Jul 12;1-7. doi: 10.1080/00365521.2020.1786850. Online ahead of print.

Objectives: Linked color imaging (LCI) is a new endoscopic technology that may increase colorectal adenoma detection rate (ADR) and polyp detection rate (PDR) by virtual chromoendoscopy. Aim of the present study was to evaluate the effectiveness of LCI in ADR and PDR compared to the HD white-light colonoscopy (WLC) technique.

Materials and methods: Between October 2016 and June 2018, we enrolled consecutive outpatients prospectively. Eligible patients allocated randomly to undergo HD WLC or LCI colonoscopy technique during instrument withdrawal. Each colonoscopy was performed in a single center by the same three expert endoscopists (with expertise more than 5000 colonoscopies).

Results: A total of 1278 patients underwent colonoscopy in the study period. ADR and PDR were significantly higher in the LCI group compared to the WLC group (34.4% vs. 26.8%; p = .007; and 53.3% vs 46.4%; p = .023, respectively). Similarly, the mean number of adenomas per patient (MAP) was significantly higher with the LCI than WLC (0.64 vs 0.44, respectively; p = .002). The mean age of patients at the time of colonoscopy was 51.95 years (SD = 13.861) in the LCI group and 51.96 years (SD = 14.028) in the WLC group. No significant differences observed in patient demographic characteristics (there was no difference in gender and age distribution, p = .986), quality of colonoscopy preparation and withdrawal times (WT) between the two groups (WLC and the LCI groups, 493.9 (SD: 143.5) and 514.0 (SD: 139.5) sec, respectively).

Conclusions: According to our results, LCI virtual chromoendoscopic technology was superior compared to conventional HD WLC in detecting colorectal polyps and adenomas.

1 Institute of Applied Health Sciences, Semmelweis University, Budapest, Hungary
2 Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
3 Endoscopy Unit, Endo-Kapszula Health Centre, Szekesfehervar, Hungary
4 Department of Gastroenterology, OMCH Endoscopy Unit, Bacs-Kiskun County Hospital, Kecskemet, Hungary

The role of linked color imaging in endoscopic diagnosis of Helicobacter pylori associated gastritis

Sang Pyo Lee1, Jin Lee1, Sea Hyub Kae1, Hyun Joo Jang1, Dong Hee Koh1, Jang Han Jung1, Sun-Ju Byeon2

Scand J Gastroenterol. 2020 Jul 15;1-7. doi: 10.1080/00365521.2020.1794025. Online ahead of print.

Objective: Linked color imaging (LCI), a novel image-enhanced endoscopy, can make it easy to recognize differences in mucosal color. It may be helpful for diagnosing H. pylori associated gastritis and H. pylori infection status. We investigated whether LCI could improve the diagnostic accuracy of H. pylori associated gastritis.

Materials and methods: Upper endoscopy was performed for 100 patients using white light imaging (WLI) and LCI. During the exam, endoscopic video was recorded. It was then analyzed by four expert endoscopists. They reviewed these videos for endoscopic diagnosis of atrophic gastritis, metaplastic gastritis, nodular gastritis and H. pylori infection. Tissue biopsies with rapid urease test were done to confirm H. pylori infection status and intestinal metaplasia.

Results: Kappa values for the inter-observer variability among the four endoscopists were fair to moderate under WLI and fair to good under LCI. Sensitivity, specificity, positive predictive value and negative predictive value for diagnosing H. pylori infection using WLI were 32.4%, 93.3%, 85.2% and 53.6%, respectively, while those for LCI were 57.4%, 91.3%, 88.7% and 64.3%, respectively. Total diagnostic accuracies for diagnosing H. pylori infection using WLI/LCI were 70.8%/78.8%. The accuracy and sensitivity of LCI for diagnosing H. pylori infection were significantly higher than those of WLI (p < .001 for both). However, there were no significant differences in the accuracy, sensitivity or specificity for diagnosing metaplastic gastritis between LCI and WLI.

Conclusions: LCI has better diagnostic accuracy for H. pylori infection status than WLI.

1 Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
2 Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea

Benefits of Linked Color Imaging for Recognition of Early Differentiated-Type Gastric Cancer: In Comparison With Indigo Carmine Contrast Method and Blue Laser Imaging

Takeshi Yasuda1,2, Nobuaki Yagi1, Tatsushi Omatsu1, Sadanari Hayashi1, Yuki Nakahata1, Yuriko Yasuda1, Akihiro Obora1, Takao Kojima1, Yuji Naito2, Yoshito Itoh2

Surg Endosc. 2020 Jun 16. doi: 10.1007/s00464-020-07706-1. Online ahead of print.

Background and aim: Linked color imaging (LCI) is a novel endoscopy system, which enhances slight differences in mucosal color. However, whether LCI is more useful than other kinds of image-enhanced endoscopy (IEE) in recognizing early gastric cancer remains unclear. This study aimed to evaluate LCI efficacy compared with the indigo carmine contrast method (IC), and blue laser imaging-bright (BLI-brt) in early differentiated-type gastric cancer recognition.

Methods: We retrospectively analyzed early differentiated-type gastric cancer, which were examined by all four imaging techniques (white light imaging, IC, LCI, BLI-brt) at Asahi University Hospital from June 2014 to November 2018. Both subjective evaluation (using ranking score: RS) and objective evaluation (using color difference score: CDS) were adopted to quantify early differentiated-type gastric cancer recognition.

Results: During this period, 87 lesions were enrolled in this study. Both RS and CDS of LCI were significantly higher (p < 0.01) than those of IC and BLI-brt. Both RS and CDS of BLI-brt had no significant difference compared with those of IC. Subgroup analysis revealed that LCI was especially useful in post-Helicobacter pylori eradication patients and flat or depressed lesions compared with IC and BLI-brt.

Conclusions: LCI appears to be more beneficial for the recognition of early differentiated-type gastric cancer in endoscopic screenings than IC and BLI-brt from the middle to distant view.

1 Department of Gastroenterology, Asahi University Hospital, 3-23 Hashimoto, Gifu 500-8523, Japan
2 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 465 Kawaramachi–Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan

A detailed comparison between the endoscopic images using blue laser imaging and three-dimensional reconstructed pathological images of colonic lesions

Takeshi Ueda1,2, Kohei Morita3, Fumikazu Koyama1,4, Yuichi Teramura5, Tadashi Nakagawa6, Shinji Nakamura7, Yayoi Matsumoto1, Takashi Inoue1, Takayuki Nakamoto 1,4, Yoshiyuki Sasaki1, Hiroyuki Kuge1, Maiko Takeda3, Chiho Ohbayashi3, Hisao Fujii8, Masayuki Sho1

PLoS One. 2020 Jun 29;15(6):e0235279. doi: 10.1371/journal.pone.0235279. eCollection 2020.

Blue laser/light imaging (BLI) is an image-enhanced endoscopy (IEE) technique that can provide an accurate diagnosis by closely observing the surface structure of various colonic lesions. However, complete correspondence between endoscopic images and pathological images has not been demonstrated. The aim of this study was to accurately compare endoscopic images and the pathological images using a three-dimensionally (3D) reconstructed pathological model. Continuous thin layer sections were prepared from colonic tissue specimens and immunohistochemically stained for CD34 and CAM5.2. Three-dimensional reconstructed images were created by superimposing immunohistochemically stained pathological images. The endoscopic image with magnifying BLI was compared with the top view of the 3D reconstructed image to identify any one-to-one correspondence between the endoscopic images and histopathological images using the gland orifices and microvessels as a guide. Using 3D reconstructed pathological images, we were able to identify the location on the endoscope image in cases of colonic adenocarcinoma, adenoma and normal mucosa. As a result, the horizontal plane of the endoscopic image and the vertical plane of the 2D pathological specimen were able to be compared, and we successfully determined the visible blood vessel depth and performed a detailed evaluation on magnifying BLI. Examples are as follows: (1) The median vasculature depth from the mucosal surface that could be recognized as vasculature on magnifying BLI was 29.4 μm. The median depth of unrecognizable vessels on magnifying BLI was 218.8 μm, which was significantly deeper than recognizable vessels. (2) Some brownish structures were suggested to potentially be not only dense vessels, vessel expansions, corrupted vessels but also bleeding or extravasation of erythrocytes. Overall, we demonstrated a new approach to matching endoscopic images and pathological findings using a 3D-reconstructed pathological model immunohistochemically stained for CD34 and CAM5.2. This approach may increase the overall understanding of endoscopic images and positively contribute to making more accurate endoscopic diagnoses.

1 Department of Surgery, Nara Medical University, Kashihara, Japan
2 Department of Surgery, Minami-Nara General Medical center, Yoshino, Nara, Japan
3 Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
4 Department of Endoscopy, Nara Medical University Hospital, Kashihara, Japan
5 Clinical Research Endoscopy System Division and Medical System Business Division, FUJIFILM Corporation, Tokyo, Japan,
6 Department of Surgery, Saiseikai Chuwa Hospital, Sakurai, Japan,
7 Department of Surgery, Takanohara Central Hospital, Nara, Japan, 8 Gastrointestinal Endoscopy and IBD center, Yoshida Hospital, Nara, Japan