Comparison of endoscopic visibility and miss rate for early gastric cancers after Helicobacter pylori eradication with white‐light imaging versus linked color imaging

Abstract

Background and Aim We aimed to investigate whether linked color imaging (LCI) improves endoscopic visibility of early gastric cancers (EGC) after Helicobacter pylori eradication, which are often difficult to detect, and reduces the miss rate when compared with white‐light imaging (WLI). Methods The visibility study used two images, one each with WLI and LCI, from 84 consecutive EGC after H. pylori eradication. Endoscopic visibility was evaluated using a visibility score and color difference (CD) value. To analyze miss rates, we studied a library of recorded videos using both WLI and LCI for 70 other consecutive patients after H. pylori eradication, among whom 19 had EGC. Endoscopic screening was done using the same protocol to map the entire stomach. Six endoscopists reviewed the videos in a randomized order. Miss rates of EGC were compared among the modalities. Results Mean [(±standard deviation) visibility scores with LCI were significantly higher than those with WLI (3.19 ± 0.84 vs 2.52 ± 0.98, P < 0.001), as were mean CD values (26.3 ± 9.1 vs 13.6 ± 6.3, P < 0.001). Miss rates of the six endoscopists were significantly lower with LCI than with WLI (30.7% vs 64.9%, P < 0.001). Both expert and trainee endoscopists had significantly better results with LCI than with WLI. Conclusions Linked color imaging significantly improved the visibility of EGC after H. pylori eradication compared with WLI using both subjective and objective criteria. Furthermore, LCI significantly reduced miss rates of these lesions compared with WLI.

Linked color imaging followed by magnifying blue laser imaging identifies early gastric cancer in map‐like redness after successful Helicobacter pylori eradication

“…However, depressed lesions similar to EGCs were sometimes detected in MR using LCI in clinical practice. Magnifying blue laser imaging (M‐BLI) has an excellent diagnostic accuracy for EGC 5 . Therefore, we recommend M‐BLI following LCI to accurately identify EGC after HP eradication in MR (Video S1).…”

Review: Diagnosis of Helicobacter pylori infection

“…With regard to detection of EGC after H pylori eradication, LCI significantly improved the mean visibility scores and coloured differences compared to WLI, leading to significantly lower miss rates compared to WLI (30.7% vs 64.0%) 9 . In a similar study, Majima et al noted map‐like redness and the absence of regular arrangements of collecting venules as a feature of EGC 10 .…”

Diagnosis of Helicobacter pylori Infection and Recent Advances

“…The specificity and PPV for endoscopic diagnosis with positive H. pylori infection based on the Spotty pattern were 95.3% and 86.5% [73]. On the aspect of LCI which is more suitable in wide-lumen organ than BLI, studies based on Kyoto Classification of Gastritis to assess the visibility of LCI, WLI, and BLI found that LCI could improve visibility especially for diffuse redness, spotty redness, map-like redness, patchy redness and red streaks [74][75][76]. When compared with that of WLI, LCI could identify H. pylori infection by enhancing endoscopic images of the diffuse redness of the fundic gland and achieve more optimal diagnostic power (accuracy 85.8% vs. 74.2%, sensitivity 93.3% vs. 81.7%, and specificity 78.3% vs. 66.7%) [77].…”