Improved Visibility of Barrett’s Esophagus with Linked Color Imaging: Inter- and Intra-Rater Reliability and Quantitative Analysis

Abstract

Background/Aims: To evaluate the usefulness of linked color imaging (LCI) and blue LASER imaging (BLI) in Barrett’s esophagus (BE) compared with white light imaging (WLI). Methods: Five expert and trainee endoscopists compared WLI, LCI, and BLI images obtained from 63 patients with short-segment BE. Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and one (decreased). Scores were evaluated to assess visibility. The inter- and intra-rater reliability (intra-class correlation coefficient) of image assessments were also evaluated. Images were objectively evaluated based on L* a* b* color values and color differences (ΔE*) in a CIELAB color space system. Results: Improved visibility compared with WLI was achieved for LCI: 44.4%, BLI: 0% for all endoscopists; LCI: 55.6%, BLI: 1.6% for trainees; and LCI: 47.6%, BLI: 0% for experts. The visibility score of trainees compared with experts was significantly higher for LCI (p = 0.02). Intra- and inter-rater reliability ratings for LCI compared with WLI were “moderate” for trainees, and “moderate-substantial” for experts. The ΔE* revealed statistically significant differences between WLI and LCI. Conclusion: LCI improved the visibility of short-segment BE compared with WLI, especially for trainees, when evaluated both subjectively and objectively.

Predictive Factors of Postendoscopic Submucosal Dissection Electrocoagulation Syndrome and the Utility of Computed Tomography Scan after Esophageal Endoscopic Submucosal Dissection

“…First, the results may be biased because it is a retrospective study at a single institution and warrants prospective, multicenter studies in the future. Second, factors associated with the skill level of the esophageal ESD operator may also affect mediastinal emphysema and PEECS outcomes [31]. Third, the pain experienced by patients following ESD was measured using NRS; however, this is a subjective assessment made by the patient, which may be influenced by their individual pain thresholds.…”

Efficacy of Full-Spectrum Endoscopy to Visualize the Major Duodenal Papilla in Patients with Familial Adenomatous Polyposis

“…All cases could be biopsied in this study. Second, FUSE EGD may be inferior to high-definition EGD in terms of neoplasm detection in esophagus and stomach because FUSE EGD does not involve image-enhanced function such as narrow band imaging, blue laser imaging, and linked color imaging, which are useful to detect esophageal squamous cell carcinoma and gastric cancer [27][28][29][30][31][32][33], although there is no difference in resolution between FUSE EGD and high-definition EGD. Third, FUSE EGD can be less cost-effective because another scope system is required to introduce FUSE EGD.…”

Linked Color Imaging and the Kyoto Classification of Gastritis: Evaluation of Visibility and Inter-Rater Reliability

“…To make it easier to discriminate the color tone of the mucosal surface, in LCI color is expanded and reduced simultaneously in acquired images so that red colors appear redder and white colors appear whiter. Studies on gastric cancer [4,5], chronic gastritis [8], Barrett's esophagus [9], and colon cancer [7] have shown LCI to be useful in improving visibility. For example, LCI was successfully used in the early detection of flat gastric cancers, observed as reddish lesions distinct from the surrounding mucosa, by Fukuda et al [4] and Ono et al [5] In a study by Kanzaki et al [6], LCI showed a larger color difference than WLI in an analysis of early gastric cancer and the surrounding mucosa.…”

“…Recent studies of cancers such as gastric [4][5][6] and colon [7], as well as chronic gastritis [8], Barrett's esophagus [9] and ulcerative colitis [10], have been undertaken using LCI. However, clinical observations based on the Kyoto Classification of Gastritis using LCI and BLI have not been reported.…”