Detection of early stage gastric cancers in screening laser endoscopy using linked color imaging for patients with atrophic gastritis

Abstract

Background and Aims Laser endoscopy involves blue laser imaging in bright mode (BLI‐bright). Linked color imaging (LCI) is superior to white light imaging (WLI) for detecting gastric cancers. This study aimed to detect gastric cancers on screening endoscopy using not only WLI but also BLI‐bright and LCI in patients with atrophic gastritis. Patients and Methods A total of 500 patients with atrophic gastritis undergoing screening esophagogastroduodenoscopy were included. The gastric lumen was observed in the WLI mode, followed by the LCI and BLI‐bright modes. When gastric neoplasms were suspected, the mode was changed to WLI, and we sprayed indigo carmine. Finally, biopsy specimens were taken for those lesions and pathological diagnosis was made. We compared the size, morphology, and color of gastric neoplasms found by the first WLI mode and those detected by only the LCI mode or BLI‐bright mode. Results We detected 16 gastric neoplasms (3.2%), of which 13 were early gastric cancers (EGCs) and three were gastric adenomas. Ten EGCs and two gastric adenomas (75%) were detected by the first WLI mode; three EGCs and one gastric adenoma (25%) were missed by the first WLI mode and were detected by the LCI mode or BLI‐bright mode. All were less than 1 cm in diameter and were reddish. Mean diameter of the lesions was significantly less for LCI‐detected or BLI‐bright‐detected lesions than for WLI‐detected lesions (7.8 vs 21.2 mm). Conclusions Laser endoscopy is useful for detecting EGCs by LCI for patients with atrophic gastritis.

Current status and future perspective of linked color imaging for gastric cancer screening: a literature review

“…Several case reports and studies have reported that LCI can more easily identify early-stage gastric cancer than the conventional white-light imaging (WLI) technique [13,14]. This has been further supported by recently published prospective studies, which have demonstrated that LCI has a higher detection ratio for gastric cancer than WLI [15][16][17]. The aim of this review was to summarize the current and future status of LCI as a diagnostic imaging method and describe its usefulness and challenges in clinical practice.…”

Diagnostic approach to Helicobacter pylori-related gastric oncogenesis

“…Specifically, gastric atrophy, intestinal metaplasia, enlarged folds and nodularity provide evidence of a gastric cancer risk [ 21 ]. In this regard, new endoscopic techniques, such as white-light imaging (WLI) and blue-laser imaging (BLI), have been considered to identify H. pylori status and gastric tumor lesions [ 22 - 24 ]. For instance, map-like redness by WLI or a cracked shape by BLI have been proposed as features of post-eradicated gastric mucosa polyps [ 18 , 19 ].…”

“…Beyond WLI and BLI, image-enhanced endoscopy (IEE), such as narrow-band imaging (NBI) or linked color imaging (LCI), with or without magnification, have also been introduced. Recent data have suggested increased diagnostic accuracy in the detection of gastrointestinal tumors with the application of these modalities during endoscopic examination [ 26 , 27 ]: NBI endoscopy has been introduced to improve the diagnosis of H. pylori -induced gastritis, preneoplastic lesions and early gastric cancer [ 28 ]; and LCI can be used to identify gastric intestinal metaplasia and, moreover, exhibits superiority to WLI for identifying H. pylori status and gastric tumors [ 22 , 24 , 29 ]. It is important to note, however, that IEE requires substantial training and a prolonged procedure time, while there are no uniform features of H. pylori infection in IEE [ 27 ].…”

Linked color imaging improves the diagnostic accuracy of eosinophilic esophagitis

“…[15][16][17] Linked color imaging (LCI) is a newly developed image-enhanced endoscopy (IEE) created by shortwavelength narrow-band laser light combined with white laser light, enabling brighter light in a distant area and enhancing color differences between red and white. 18,19 Accumulating evidence has shown that LCI is helpful not only for the diagnosis of pre-cancerous/cancerous lesions in the GI tract [20][21][22][23][24][25][26] but also for some inflammatory conditions such as reflux esophagitis, 27,28 Helicobacter pylori gastritis, 29 and ulcerative colitis. 30 However, the usefulness of this technology for the endoscopic diagnosis of EoE remains unclear.…”