A prospective randomized tandem gastroscopy pilot study of linked color imaging versus white light imaging for detection of upper gastrointestinal lesions

Abstract

Background and Aim Gastrointestinal (GI) lesions may have subtle morphological changes. Linked color imaging (LCI) combines narrow‐band wavelength light and white light imaging (WLI) in appropriate balance to enhance lesion detection. We compared the detection rates of upper GI lesions using LCI and WLI. Method Patients were randomized in a 1:1 ratio to receive tandem gastroscopy with WLI inspection followed by LCI, or vice versa. Endoscopic examination was performed using the EG‐L590ZW gastroscope and the LASEREO endoscope system (Fujifilm Co., Tokyo, Japan). Histology was reported by a specialist GI pathologist blinded to the technique of lesion detection and was used as the gold standard for diagnosis. Results Ninety patients (mean age 66.8 years, 51.5% male patients) were randomized to either LCI examination first followed by WLI (LCI‐WLI), or vice versa (WLI‐LCI). An 18.9% of gastroscopies in the study were for surveillance of previously known gastric cancer precursors. Ten patients (11.1%) had a history of Helicobacter pylori infection. There was no significant difference in the time taken for examination under LCI (311 ± 96 s) and WLI (342 ± 86 s) (P = 0.700). LCI detection rates were higher than WLI detection rates for gastric cancer precursors such as atrophic gastritis (2.19% vs 0.55%) (P < 0.01) and intestinal metaplasia (19.73% vs 7.67%) (P < 0.01). Both sensitivity (82.74% vs 50.96%) and specificity (98.71% vs 96.10%) of LCI were higher than WLI for detection of upper GI lesions. Conclusions Linked color imaging had better detection rates, sensitivity, and specificity for detection of upper GI lesions compared with WLI.

Quality indicators in the endoscopic detection of gastric cancer

“…IEE improves the detection of precancerous atrophic and metaplastic gastric mucosa and shows promise as a tool for mapping the severity of metaplastic change. 63 , 64 , 65 , 66 , 67 IEE also enables endoscopic diagnosis of H. pylori infection status. 68 , 69 IEE, especially with magnification, aids in the characterization of gastric neoplasia but detection has been more challenging (Figure 5 ), A multi‐centered randomized controlled trial of over 4500 patients comparing second‐generation NBI with white light imaging showed no significant difference in the detection of early GC.…”

“…The advent of image‐enhanced endoscopy (IEE) has addressed some of the shortcomings of white light examination in detecting mucosa at risk of GC and the detection and characterization of gastric neoplasia. IEE improves the detection of precancerous atrophic and metaplastic gastric mucosa and shows promise as a tool for mapping the severity of metaplastic change 63–67 . IEE also enables endoscopic diagnosis of H. pylori infection status 68,69 .…”

Detection of Early Gastric Cancer after <b><i>Helicobacter pylori</i></b> Eradication

“…There are several reports on the usefulness of image-enhanced endoscopy (i.e., linked color imaging, narrow-band imaging, and i-scan optical enhancement) for gastric cancer detection before eradication [35-38]. However, there are limited reports regarding detection of gastric cancer after eradication by image-enhanced endoscopy.…”

Performance status of targeted biopsy alone versus Sydney protocol by non-NBI expert gastroenterologist in gastric intestinal metaplasia diagnosis

“…Diagnosis of GIM needs close attention from an endoscopist for subtle mucosal changes, which can be easily overlooked 8 . Because white light endoscopy (WLE) alone is not sufficient to diagnose these changes, various techniques have been developed to enhance the sensitivity of detection, such as image-enhanced endoscopy (IEE) with or without magnification 9 10 11 , otherwise an additional random biopsy (Sydney protocol) to cover the potential missing lesions is recommended for implementation 12 . In 2019, British Society of Gastroenterology guidelines recommended the use of IEE, e.g.…”

“…To date, there has been no direct comparison of the performance status of targeted biopsy with NBI and NBI-targeted biopsy plus random biopsies under the Sydney protocol in patients with GIM. Moreover, all previous studies related to the benefit of targeted biopsy involved experts in NBI 9 10 11 . Therefore, this study aimed to compare the performance status of these two strategies for diagnosis of extensive GIM, performed gastroenterologists who were not expert at NBI.…”