Current status and future perspective of linked color imaging for gastric cancer screening: a literature review

Abstract

Screening endoscopy has advanced to facilitate improvements in the detection and prognosis of gastric cancer. However, most early gastric cancers (EGCs) have subtle morphological or color features that are difficult to detect by white-light imaging (WLI); thus, even well-trained endoscopists can miss EGC when using this conventional endoscopic approach. This review summarizes the current and future status of linked color imaging (LCI), a new image-enhancing endoscopy (IEE) method, for gastric screening. LCI has been shown to produce bright images even at a distant view and provide excellent visibility of gastric cancer due to high color contrast relative to the surrounding tissue. LCI delineates EGC as orange-red and intestinal metaplasia as purple, regardless of a history of Helicobacter pylori (Hp) eradication, and contributes to the detection of superficial EGC. Moreover, LCI assists in the determination of Hp infection status, which is closely related to the risk of developing gastric cancer. Transnasal endoscopy (ultra-thin) using LCI is also useful for identifying gastric neoplastic lesions. Recently, several prospective studies have demonstrated that LCI has a higher detection ratio for gastric cancer than WLI. We believe that LCI should be used in routine upper gastrointestinal endoscopies.

Research trends in endoscopic applications in early gastric cancer: A bibliometric analysis of studies published from 2012 to 2022

“…White-light endoscopy (WLE) is a conventional and the most frequently used endoscopic technique in clinics, but it cannot always detect certain subtle morphological and color features ( 37 ). Because of its limited sensitivity, more advanced endoscopic imaging modalities that can be used for lesion detection have been developed ( 10 ).…”

Global progress and future prospects of early gastric cancer screening

“…Linked color imaging (LCI) includes a larger component of narrow-wavelength light that can be absorbed specifically by hemoglobin, facilitating the highlighting of microstructures and blood vessels on the mucosal surface and providing clear distance imaging without magnification 64 , 65 . A report highlighted that LCI has a significantly higher mean color difference compared to WLI [17.2 (5.9) vs. 10.1 (4.4)], depicting its effectiveness in highlighting mucosal changes 66 .…”

Endoscopic Imaging for the Diagnosis of Neoplastic and Pre-Neoplastic Conditions of the Stomach

“…Similarly to NBI, BLI also showed high diagnostic accuracy for the detection and characterization of GC [44,48]. The linked color imaging (LCI), also by Fujifilm, emphasizes the contrast of hemoglobin by expanding the color redness and, therefore, producing bright images that can improve the visibility of lesions [49,50]. In a multicenter randomized trial, the percentage of patients with one or more neoplastic lesions diagnosed with LCI was higher than with WLE (8.0%; 95% CI, 6.2-10.2% vs. 4.8%; 95% CI, 3.4-6.6%), and the proportion of patients with overlooked neoplasms was lower in the LCI group than in the WLE group (0.67%; 95% CI, 0.2-1.6% vs. 3.5%; 95% CI, 2.3-5.0%).…”