Colorectal sessile serrated lesion detection using linked-color imaging versus narrow-band imaging: a parallel randomized controlled trial

Abstract

Background and study aims: Previous studies have reported the effectiveness of narrow-band imaging (NBI) and linked-color imaging (LCI) in improving the detection of colorectal neoplasms. However, there has been no direct comparison between LCI and NBI in detecting colorectal sessile serrated lesions (SSLs). The present study aims to compare the effectiveness of detecting colorectal SSLs between LCI and NBI. Patients and methods: A prospective, parallel, randomized controlled trial was conducted. The participants were randomly assigned to the LCI arm and NBI arm. The primary endpoint was the SSL detection rate (SDR). Results: A total of 406 patients were involved, with 204 patients in the LCI arm and 202 patients in the NBI arm. The total polyp detection rate, adenoma detection rate and SDR was 54.2%, 38.7%, and 10.8%, respectively. The SDR had no significant difference between the LCI arm and the NBI arm (12.3% vs 9.4%, P = 0.356). The differences in the detection rate and the per-patient number of polyps, adenomas, diminutive lesions and flat lesions between LCI and NBI also had no statistical significance. Multivariate analysis showed that LCI or NBI was not an independent factor associated with SDR, whereas Boston Bowel Preparation Scale (OR: 1.346, 95% CI: 1.031-1.758, P = 0.029), withdrawal time (OR: 1.125, 95% CI: 1.003-1.261, P = 0.044) and operator experience (OR: 3.730, 95% CI: 1.672-8.322, P = 0.001) were independent factors associated with SDR. Conclusions: LCI and NBI is comparable for SSL detection, as well as for polyps and adenomas detection.

Surveillance esophagogastroduodenoscopy using linked color imaging and narrow‐band imaging: A multicenter randomized controlled trial

“…Although there have been recent reports on the similarity in visibility and detection rates of colon polyps by WLI with different light sources and different endoscopy systems, further studies are needed in the future. 24,25 Twelve gastric lesions that were not detected by primary 2G-NBI were detected by WLI (accounting for 41.4% of the gastric lesions detected in the 2G-NBI group). This percentage is similar to the results of a study by Yoshida et al showing that 22.4% of early gastric cancers were overlooked by primary 2G-NBI.…”

“…The endoscopy systems used in this study had different light sources: a xenon lamp for the 2G‐NBI group and a laser for the LCI group. Although there have been recent reports on the similarity in visibility and detection rates of colon polyps by WLI with different light sources and different endoscopy systems, further studies are needed in the future 24,25 …”

Standard screening high-definition colonoscopy without any optimization device is no longer relevant: Time to move to optimized screening colonoscopy

“…Contrast enhancement devices developed by other companies – such as new-generation narrow-band imaging (NBI, Olympus), I-scan (Pentax) or, more recently, texture and color enhancement imaging (TXI, Olympus) – also seem to yield good results when compared with HD-WLI colonoscopy 14 15 . Few studies have compared contrast enhancement devices among themselves 16 17 . In any case, every endoscopy unit has its own endoscope fleet from one of the aforementioned companies and is fairly captive to this company as regards the choice of the contrast enhancement device.…”

How to optimize the detection of serrated lesions: old tools for a new story?

“…Nevertheless, the data collected by Li Jun et al [3] provide other interesting insights. First, the adenoma miss rate for both the LCI and NBI arms, resulting from a subgroup analysis, remains high (22.0 % and 30.3 %, respectively), and comparable to that reported for HD white-light colonoscopy.…”

“…The article by Li Jun et al [3] fits right into the groove of this technology-driven path, by testing, in a parallel randomized controlled trial, whether it is the NBI or the LCI system that can best contribute to the identification of colonic polyps, particularly SSLs. The absence of a control group, namely patients undergoing conventional HD white-light colonoscopy, prevents any further clarification of the potential role of electronic chromoendoscopy for SSL detection.…”