Linked color imaging improves the visibility of colorectal polyps: a video study

 

 Permissions and Reprints

Abstract

Background/study aim Linked color imaging (LCI) by a laser endoscope (Fujifilm Co, Tokyo, Japan) is a novel narrow band light observation. In this study, we aimed to investigate whether LCI could improve the visibility of colorectal polyps using endoscopic videos.

Patients and methods We prospectively recorded videos of consecutive polyps 2 – 20 mm in size diagnosed as neoplastic polyps. Three videos, white light (WL), blue laser imaging (BLI)-bright, and LCI, were recorded for each polyp by one expert. After excluding inappropriate videos, all videos were evaluated in random order by two experts and two non-experts according to a published polyp visibility score from four (excellent visibility) to one (poor visibility). Additionally, the relationship between polyp visibility scores in LCI and various clinical characteristics including location, size, histology, morphology, and preparation were analyzed compared to WL and BLI-bright.

Results We analyzed 101 colorectal polyps (94 neoplastic) in 66 patients (303 videos). The mean polyp size was 9.0 ± 8.1 mm and 54 polyps were non-polypoid. The mean polyp visibility scores for LCI (2.86 ± 1.08) were significantly higher than for WL and BLI-bright (2.53 ± 1.15, P < 0.001; 2.73 ± 1.47, P < 0.041). The ratio of poor visibility (score 1 and 2) was significantly lower in LCI for experts and non-experts (35.6 %, 33.6 %) compared with WL (49.6 %, P = 0.015, 50.5 %, P = 0.046). The polyp visibility scores for LCI were significantly higher than those for WL for all of the factors. With respect to the comparison between BLI-bright and WL, the polyp visibility scores for BLI-bright were not higher than WL for right-sided location, < 10 mm size, sessile serrated adenoma and polyp histology, and poor preparation. For those characteristics, LCI improved the lesions with right-sided location, SSA/P histology, and poor preparation significantly better than BLI.

Conclusions LCI improved polyp visibility compared to WL for both expert and non-expert endoscopists. It is useful for improving polyp visibility in any location, any size, any morphology, any histology, and any preparation level.

Study registration: UMIN000013770

• References

• 1 Vogelstein B, Fearon ER, Hamilton SR. et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988; 319: 525-532
  CrossrefPubMedGoogle Scholar
• 2 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
  CrossrefPubMedGoogle Scholar
• 3 Kudo S, Tamegai Y, Yamano H. et al. Endoscopic mucosal resection of the colon: the Japanese technique. Gastrointest Endosc Clin N Am 2001; 11: 519-535
  PubMedGoogle Scholar
• 4 Tanaka S, Haruma K, Oka S. et al. Clinicopathological features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 2001; 54: 62-66
  CrossrefPubMedGoogle Scholar
• 5 van Rijn JC, Reitsma JB, Stoker J. et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006; 101: 343-350
  CrossrefPubMedGoogle Scholar
• 6 Adler A, Pohl H, Papanikolaou IS. et al. A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect?. Gut 2008; 57: 59-64
  PubMedGoogle Scholar
• 7 Rex DK, Helbig C. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging. Gastroenterology 2007; 133: 42-47
  CrossrefPubMedGoogle Scholar
• 8 Inoue T, Murano M, Murano N. et al. Comparative study of conventional colonoscopy and pan-colonic narrow-band imaging system in the detection of neoplastic colonic polyps: a randomized controlled trial. J Gastroenterol 2008; 43: 45-50
  CrossrefPubMedGoogle Scholar
• 9 Horimatsu T, Sano Y, Tanaka S. et al. Next-generation narrow band imaging system for colonic polyp detection: a prospective multicenter randomized trial. Int J Colorectal Dis 2015; 30: 947-954
  CrossrefPubMedGoogle Scholar
• 10 Chung SJ, Kim D, Song JH. et al. Efficacy of computed virtual chromoendoscopy on colorectal cancer screening: a prospective, randomized, back-to-back trial of Fuji Intelligent Color Enhancement versus conventional colonoscopy to compare adenoma miss rates. Gastrointest Endosc 2010; 72: 136-142
  CrossrefPubMedGoogle Scholar
• 11 Pohl J, Lotterer E, Balzer C. et al. Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial. Gastrointest Endosc 2009; 69: 734-741
  CrossrefPubMedGoogle Scholar
• 12 Yoshida N, Hisabe T, Inada Y. et al. The ability of a novel blue laser imaging system for the diagnosis of invasion depth of colorectal neoplasms. J Gastroenterol 2014; 49: 73-80
  CrossrefPubMedGoogle Scholar
• 13 Yoshida N, Yagi N, Inada Y. et al. The ability of a novel blue laser imaging system for the diagnosis of colorectal polyps. Dig Endosc 2014; 26: 250-258
  CrossrefPubMedGoogle Scholar
• 14 Miyaki R, Yoshida S, Tanaka S. et al. A computer system to be used with laser-based endoscopy for quantitative diagnosis of early gastric cancer. J Clin Gastroenterol 2015; 49: 108-115
  CrossrefPubMedGoogle Scholar
• 15 Osawa H, Yamamoto H. Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology. Dig Endosc 2014; 26 (Suppl. 01) 105-115
  CrossrefPubMedGoogle Scholar
• 16 Yoshida N, Hisabe T, Hirose R. et al. Improvement in the visibility of colorectal polyps by using blue laser imaging. Gastrointest Endosc 2015; 82: 542-549
  CrossrefPubMedGoogle Scholar
• 17 Sun X, Dong T, Bi Y. et al. Linked color imaging application for improving the endoscopic diagnosis accuracy: a pilot study. Sci Rep 2016; 6: 33473
  CrossrefPubMedGoogle Scholar
• 18 Yamashina T, Takeuchi Y, Uedo N. et al. Diagnostic features of sessile serrated adenoma/polyps on magnifying narrow band imaging: a prospective study of diagnostic accuracy. J Gastroenterol Hepatol 2015; 30: 117-123
  PubMedGoogle Scholar
• 19 Participants in the Paris workshop. The Paris endoscopic classification of superficial neoplastic lesions: Esophagus, stomach, and colon-November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (Suppl) S3-S43
  CrossrefPubMedGoogle Scholar
• 20 Yoshida N, Naito Y, Murakami T. et al. Safety and efficacy of a same-day low-volume 1 L PEG bowel preparation in colonoscopy for the elderly people and people with renal dysfunction. Dig Dis Sci 2016; 61: 3229-3235
  CrossrefPubMedGoogle Scholar
• 21 Hamilton SR, Aaltonen LA, eds. World Health Organization classification of tumors. Pathology and genetics of tumours of the digestive system. Lyon, France: IARC Press; 2010: 104-109
  Google Scholar
• 22 Dohi O, Yagi N, Onozawa Y. et al. Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection. Endosc Int Open 2016; 4: E800-805
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Froehlich F, Wietlisbach V, Gonvers JJ. et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005; 6: 378-384
  PubMedGoogle Scholar
• 24 Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003; 58: 76-79
  CrossrefPubMedGoogle Scholar
• 25 Ogiso K, Yoshida N, Siah KTH. et al. New generation narrow band imaging improves visibility of polyps: a colonoscopy video evaluation study. J Gastroenterol 2016; 51: 883-890
  CrossrefPubMedGoogle Scholar