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

Shinozaki, Satoshi; Kobayashi, Yasutoshi; Hayashi, Yoshikazu; Sakamoto, Hirotsugu; Sunada, Keijiro; Lefor, Alan Kawarai; Yamamoto, Hironori

doi:10.1111/den.13613

Cited by 63 publications

(47 citation statements)

References 28 publications

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“…Multivariable logistic regression analysis showed that flat polyp detection was significantly better with LCI than with WL (Table 4). This finding is consistent with the results of a systematic review and meta-analysis regarding the use of LCI [15].…”

Section: Ta B L E 1 Patient Baseline Characteristics and Their Clinical Featuressupporting

confidence: 92%

Linked colour imaging versus white‐light colonoscopy for the detection of flat colorectal lesions: A randomized controlled trial

et al. 2021

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Aim: Linked colour imaging is an image-enhanced endoscopy system that emphasizes the red portion of the mucosa's colour. Our aim was to compare the effectiveness of linked colour imaging with white-light colonoscopy for the detection of flat-type colorectal polyps. Method:This was a single-centre, randomized controlled trial. Enrolled patients were those aged ≥50 years undergoing cap-assisted colonoscopy for colorectal cancer screening. They were randomized in a 1:1 ratio for observation using linked colour imaging or white-light colonoscopy. All colorectal polyps detected were removed or biopsied. The primary outcome was the number of flat-type polyps per patient in patients in whom flat polyps were detected. Secondary outcomes included adenoma and polyp detection rates.Results: There were 302 subjects randomized: 152 to linked colour imaging and 150 to white-light colonoscopy. There were no differences in the clinical features between the two arms. The number of flat polyps detected per patient using linked colour imaging was approximately twice that with white light (2.9 ± 3.0 vs 1.2 ± 1.6, p = 0.045). Linked colour imaging also proved superior to white-light colonoscopy in terms of adenoma and polyp detection rates [adenomas 66% (101/152) vs 49% (73/150), p = 0.0024; polyps 69% (105/152) vs 55% (82/150), p = 0.013]. The ratio of polyps detected in the right colon compared with those detected in the left colon was significantly greater using linked colour than white-light imaging (168/64 vs 93/84; p < 0.001). Conclusion:Compared with white-light colonoscopy, linked colour imaging improved adenoma and polyp detection rates, including detection of flat-type colorectal polyps. K E Y W O R D S colonoscopy, colorectal adenoma, colorectal polyp, adenoma detection rate, linked colour imaging What does this paper add to the literature? This is the first study to compare the effectiveness of cap-assisted linked colour imaging colonoscopy and cap-assisted white-light colonoscopy in the detection of flat-type colorectal polyps in a prospective randomized trial. Secondary outcomes included overall adenoma and polyp detection rates. Adenoma and polyp detection rates including detection of flat-type colorectal polyps were improved with linked colour imaging compared with white-light colonoscopy. How to cite this article: Kudo T, Horiuchi A, Kyodo R, et al. Linked colour imaging versus white-light colonoscopy for the detection of flat colorectal lesions: A randomized controlled trial.

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Section: Ta B L E 1 Patient Baseline Characteristics and Their Clinical Featuressupporting

confidence: 92%

Linked colour imaging versus white‐light colonoscopy for the detection of flat colorectal lesions: A randomized controlled trial

et al. 2021

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“…Finally, the new-generation models with image enhanced technologies, such as Linked Color Imaging by Fujifilm, could offer better visualization 42 and have the potential to supersede white-light colonoscopy; thus, the effectiveness of CADe using the latest models of endoscope should be further investigated. Supplementary Figure S1.…”

Section: Discussionmentioning

confidence: 99%

Lower Adenoma Miss Rate of Computer-Aided Detection-Assisted Colonoscopy vs Routine White-Light Colonoscopy in a Prospective Tandem Study

et al. 2020

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See Covering the Cover synopsis on page 1193. BACKGROUND AND AIMS: Up to 30% of adenomas might be missed during screening colonoscopy-these could be polyps that appear on-screen but are not recognized by endoscopists or polyps that are in locations that do not appear on the screen at all. Computer-aided detection (CADe) systems, based on deep learning, might reduce rates of missed adenomas by displaying visual alerts that identify precancerous polyps on the endoscopy monitor in real time. We compared adenoma miss rates of CADe colonoscopy vs routine white-light colonoscopy. METHODS: We performed a prospective study of patients, 18-75 years old, referred for diagnostic, screening, or surveillance colonoscopies at a single endoscopy center of Sichuan Provincial People's Hospital from June 3, 2019 through September 24, 2019. Same day, tandem colonoscopies were performed for each participant by the same endoscopist. Patients were randomly assigned to groups that received either CADe colonoscopy (n¼184) or routine colonoscopy (n¼185) first, followed immediately by the other procedure. Endoscopists were blinded to the group each patient was assigned to until immediately before the start of each colonoscopy. Polyps that were missed by the CADe system but detected by endoscopists were classified as missed polyps. False polyps were those continuously traced by the CADe system but then determined not to be polyps by the endoscopists. The primary endpoint was adenoma miss rate, which was defined as the number of adenomas detected in the second-pass colonoscopy divided by the total number of adenomas detected in both passes. RESULTS: The adenoma miss rate was significantly lower with CADe colonoscopy (13.89%; 95% CI, 8.24%-19.54%) than with routine colonoscopy (40.00%; 95% CI, 31.23%-48.77%, P<.0001). The polyp miss rate was significantly lower with CADe colonoscopy (12.98%; 95% CI, 9.08%-16.88%) than with routine colonoscopy (45.90%; 95% CI, 39.65%-52.15%) (P<.0001). Adenoma miss rates in ascending, transverse, and descending colon were significantly lower with CADe colonoscopy than with routine colonoscopy (ascending colon 6.67% vs 39.13%; P¼.0095; transverse colon 16.33% vs 45.16%; P¼.0065; and descending colon 12.50% vs 40.91%, P¼.0364). CONCLUSIONS: CADe colonoscopy reduced the overall miss rate of adenomas by endoscopists using white-light endoscopy. Routine use of CADe might reduce the incidence of interval colon cancers. chictr.org.cn study no: ChiCTR1900023086

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“…Data on LCI for the detection of colorectal lesions are preliminary but promising. [14][15][16][17][18][19] To this date, no study has assessed LCI for polyp detection in patients with Lynch syndrome. The aim of this study was to assess if LCI is superior to HD-white light endoscopy (WLE) for the detection of polyps during surveillance colonoscopy of patients with Lynch syndrome.…”

Section: What Are the New Findings?mentioning

confidence: 99%

Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Houwen

Hazewinkel

Pellisé

et al. 2021

Gut

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ObjectiveDespite regular colonoscopy surveillance, colorectal cancers still occur in patients with Lynch syndrome. Thus, detection of all relevant precancerous lesions remains very important. The present study investigates Linked Colour imaging (LCI), an image-enhancing technique, as compared with high-definition white light endoscopy (HD-WLE) for the detection of polyps in this patient group.DesignThis prospective, randomised controlled trial was performed by 22 experienced endoscopists from eight centres in six countries. Consecutive Lynch syndrome patients ≥18 years undergoing surveillance colonoscopy were randomised (1:1) and stratified by centre for inspection with either LCI or HD-WLE. Primary outcome was the polyp detection rate (PDR).ResultsBetween January 2018 and March 2020, 357 patients were randomised and 332 patients analysed (160 LCI, 172 HD-WLE; 6 excluded due to incomplete colonoscopies and 19 due to insufficient bowel cleanliness). No significant difference was observed in PDR with LCI (44.4%; 95% CI 36.5% to 52.4%) compared with HD-WLE (36.0%; 95% CI 28.9% to 43.7%) (p=0.12). Of the secondary outcome parameters, more adenomas were found on a patient (adenoma detection rate 36.3%; vs 25.6%; p=0.04) and a colonoscopy basis (mean adenomas per colonoscopy 0.65 vs 0.42; p=0.04). The median withdrawal time was not statistically different between LCI and HD-WLE (12 vs 11 min; p=0.16).ConclusionLCI did not improve the PDR compared with HD-WLE in patients with Lynch syndrome undergoing surveillance. The relevance of findings more adenomas by LCI has to be examined further.Trial registration numberNCT03344289.

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

Cited by 63 publications

References 28 publications

Linked colour imaging versus white‐light colonoscopy for the detection of flat colorectal lesions: A randomized controlled trial

Linked colour imaging versus white‐light colonoscopy for the detection of flat colorectal lesions: A randomized controlled trial

Lower Adenoma Miss Rate of Computer-Aided Detection-Assisted Colonoscopy vs Routine White-Light Colonoscopy in a Prospective Tandem Study

Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

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