Linked color imaging improves the endoscopic visibility of gastric mucosal cancers

Abstract

Background and study aims As a newly developed endoscopy technique, linked color imaging (LCI) provides very bright images with enhanced color tones. With the objective of improving the detection rate of gastric mucosal cancers, which are often difficult to detect, we examined the utility of LCI from the viewpoint of visibility. Patients and methods The current study used 100 consecutive gastric mucosal cancers ≤ 20 mm in diameter. For each lesion, we selected one endoscopic image acquired by white-light imaging (WLI), blue-laser imaging (BLI) -bright, and LCI modes. Four endoscopists interpreted the images; using a previously reported scale, we scored the visibility level on a scale of 1 – 4. Results The mean (± SD) visibility scores were 2.54 ± 1.10 for WLI, 3.02 ± 1.07 for BLI-bright, and 3.28 ± 0.97 for LCI. The score was significantly higher for BLI-bright compared with WLI ( P < .001) and again higher for LCI compared with BLI-bright ( P < .001). For the experts, the scores for BLI-bright and LCI were similar, but both were significantly higher than the score for WLI. For the trainees, there was no significant difference between the WLI and BLI-bright scores, but LCI score was significantly higher than those for WLI and BLI-bright scores. With regard to clinical characteristics, LCI particularly enhanced visibility of normochromic, flat and depressed lesions, which had the lowest visibility scores of all three modalities compared with those of the other lesions. Conclusion LCI increased visibility and may contribute to early detection of gastric mucosal cancers.

RGB Pixel Brightness Characteristics of Linked Color Imaging in Early Gastric Cancer: A Pilot Study

“…Compared to WLI, LCI particularly enhanced the visibility of a normochromic, flat, and depressed lesion, which contributes to the early detection of gastric mucosal cancer [3]. Therefore, RGB pixel brightness as a potential way to improve the accuracy of EGC screening is an additional benefit to LCI.…”

“…The LCI observation mode is one of the four modes offered by the IEE system. The main feature is color enhancement that makes it easier to recognize the slight difference in mucosal color [3]. For instance, lesions with HP infection were identified with a diffusion of red color [4].…”

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

“…O UR PREVIOUS STUDY showed that LCI improved the visibility of EGC in general, according to the subjective visibility scale. 24 In the current study, we evaluated the efficacy of LCI for detecting EGC after eradication, which are more difficult to detect compared to EGC in general. When using the same visibility scales, a similar result was obtained for EGC after eradication.…”

“…The endoscopists scored the lesions based on a previously reported four-point visibility scale. 15,24,28 With respect to the objective analyses, we evaluated the color difference (CD) of each lesion on WLI and LCI images using the Commission Internationale d'Eclairage (CIE) L*a*b* color space and delta ELab formulas. This was done using commercially available image analysis software (Adobe Photoshop; Adobe Systems, San Jose, CA, USA).…”

“…[14][15][16][17][18][19] LCI improve the visibility of EGC when evaluated using subjective or objective criteria. [20][21][22][23][24] However, limited information is available concerning the efficacy of LCI for detecting EGC after eradication. Design of previous studies was unsatisfactory because only still images of EGC were evaluated.…”