Linked color imaging reduces the miss rate of neoplastic lesions in the right colon: a randomized tandem colonoscopy study

Background and Aim Linked color imaging (LCI) is a novel image‐enhancing technology which enhances color differences between a colorectal lesion and surrounding mucosa with enough brightness to illuminate the wide colorectal lumen. The aim of this study is to compare colorectal polyp detection using LCI with that using white light imaging (WLI). Methods Randomized controlled trials and prospective studies comparing LCI with WLI for colorectal polyp detection were selected. Outcomes included overall polyp/adenoma detection and additional polyp detection at a second observation. Outcomes were documented by pooled risk ratios (RR) with 95% confidence interval (CI) using the Mantel‐Haenszel random effect model. Results Seven studies were included. LCI showed significant superiority for polyp and adenoma detection compared with WLI (RR 1.16, 95% CI 1.09–1.25, P < 0.001 for polyp detection; RR 1.26, 95% CI 1.14–1.39 P < 0.001 for adenoma detection). LCI significantly increased the number of polyps detected per patient compared with WLI (mean difference 0.27, 95% CI 0.01–0.53, P = 0.040). LCI significantly increased the number of adenomas detected per patient compared with WLI (mean difference 0.22, 95% CI 0.08–0.36, P = 0.002). LCI significantly increased the number of flat polyps detected per patient compared with WLI (mean difference 0.14, 95% CI 0.01–0.27, P = 0.040). LCI had a significantly higher rate of additional polyp detection compared with WLI in the right colon (RR 2.68, 95% CI 1.71–4.19, P < 0.001). Conclusions Linked color imaging has significantly greater polyp and adenoma detection rates and detection rate of previously missed polyps compared with WLI. We recommend the initial use of LCI for routine colonoscopy.

Section: Characteristics Of Studiesmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Section: Additional Polyp Detection In the Right Colonmentioning

confidence: 99%

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Colon polyp detection using linked color imaging compared to white light imaging: Systematic review and meta‐analysis

Shinozaki

Kobayashi

Hayashi

et al. 2020

“…13 LCI has been found to have benefits in the detection and recognition of gastrointestinal neoplasms. [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.…”

Section: Introductionmentioning

confidence: 99%

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

Kitagawa

Suzuki

Nankinzan

et al. 2019

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.

“…LCI images enhance differences in the hue of the red region of the spectrum, making red areas appear redder and white areas appear whiter . LCI images are reported to improve the detection of gastrointestinal neoplastic lesions compared to WLI …”

Section: Introductionmentioning

confidence: 99%

Objective evaluation of the visibility of colorectal lesions using eye tracking

Kumahara

Ikematsu

Shinmura

et al. 2019

Background and Aim To assess the visibility of colorectal lesions using blue laser imaging (BLI)‐bright and linked‐color imaging (LCI) with an eye‐tracking system. Methods Eleven endoscopists evaluated 90 images of 30 colorectal lesions. The lesions were randomly selected. Three images of each lesion comprised white light imaging (WLI), BLI‐bright, and LCI in the same position. Participants gazed at the images, and their eye movements were tracked by the eye tracker. We analyzed whether the participants could detect the lesion and how long they took to detect the lesion. We assessed the miss rate and detection time among the imaging modalities. Results One endoscopist was excluded, and 10 endoscopists were assessed. Overall, 12.6% of lesions were missed with WLI, 6.0% with BLI‐bright, and 4.3% with LCI; the miss rate of BLI‐bright and LCI was significantly lower than that of WLI (P < 0.01), with no significant difference between the former modalities (P = 0.54). Mean (± SD) detection times were 1.58 ± 1.60 s for WLI, 1.01 ± 1.21 s for BLI‐bright, and 1.10 ± 1.16 s for LCI. Detection time for BLI‐bright and LCI was significantly shorter than that for WLI (P < 0.0001), with no significant difference between the former modalities (P = 0.34). Regarding the miss rate and detection time between the expert and the non‐experts, there was a significant difference with WLI but not with BLI‐bright and LCI. Conclusion Blue laser imaging‐bright and LCI improved the detection of colorectal lesions compared with WLI using an eye‐tracking system.