Abstract:Background and study aims Ultrathin endoscopy causes a minimal gag reflex and has minimal effects on cardiopulmonary function. Linked color imaging (LCI) is useful for detection of malignancies in the digestive tract. The aim of this study was to clarify whether LCI with ultrathin endoscopy facilitates detection of early gastric cancer (EGC) despite its lower resolution compared with high-resolution white light imaging (WLI) with standard endoscopy.
Patients and methods This was a retrospective analy… Show more
“…In such background mucosa, early detection of gastric cancer is difficult even for well-trained endoscopists, and EGCs are often missed during screening endoscopy using WLI alone [ 9 – 12 ]. Table 1 shows a summary of studies on LCI for the detection of gastric neoplasms [ 15 – 17 , 27 , 28 , 46 , 50 – 69 ]. To prepare Table 1 , we identified relevant studies in the literature by searching the databases of PubMed (Fig.…”
Section: Lci For Screening Of Egcmentioning
confidence: 99%
“…Non-experts placed the biopsy mark more accurately with LCI (82.3% vs. 87.2%, P < 0.001). Non-experts were indicated to prefer LCI over WLI Khurelbaatar et al [ 67 ] 2022 Retrospective/SC 508 EGCs from 456 patients Images of EGCs LCI significantly improved visibility of EGC regardless of differences in lesion morphology, histology, location, depth of invasion, and Hp status compared with conventional WLI Ishida et al [ 28 ] 2022 Retrospective/SC 99 EGC lesions from 88 patients Videos of EGCs and gastric mucosa captured using LED and laser endoscopy LED-WLI and LED-LCI can be used to visualize EGCs with non-inferiority to Laser-WLI and Laser-LCI Haruma et al [ 68 ] 2022 RCT/MC 1502 patients (patients with a history of gastrointestinal cancer) Real-time observation The detection rate of upper gastrointestinal neoplasms tended to be higher with LCI than with WLI among patients who underwent ultra-slim endoscopy Khurelbaatar et al [ 69 ] 2022 Retrospective/SC 52 EGCs and 29 nonmalignant lesions Video including cases of EGC or gastric atrophy alone using standard and ultra-thin endoscopies Ultra-thin LCI had a higher diagnostic sensitivity and significantly higher visibility scores and color difference than standard WLI SC single-center, MC multicenter, RCT randomized controlled trial, EGC early gastric cancer, IM intestinal metaplasia, LCI linked color imaging, WLI white-light imaging, BLI blue laser imaging, LED light-emitting diode, Hp Helicobacter pylori , M-Chromo-LCI magnifying linked color imaging with indigo carmine dye, M-BLI magnifying blue laser imaging, MR map-like redness, IC indigo carmine contrast method, CI confidence interval, AIM acetic acid indigo carmine mixture Fig. 2 PRISMA 2009 flow diagram describing the selection of the studies included in our review …”
Section: Lci For Screening Of Egcmentioning
confidence: 99%
“…Using data from the LCI-further improving neoplasm detection in upper gastrointestinal (LCI-FIND) trial, a sub-analysis showed that LCI is useful in identifying neoplastic lesions of the pharynx, esophagus, and stomach when used in ultra-slim endoscopy [ 68 ]. Khurelbaatar et al [ 69 ] further demonstrated that ultra-thin LCI had a higher diagnostic sensitivity and significantly higher visibility scores and color differences than standard WLI. These results suggest that color contrast is more important than resolution for EGC identification.…”
Section: Transnasal Endoscopy With Lci In Detecting Egcmentioning
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.
“…In such background mucosa, early detection of gastric cancer is difficult even for well-trained endoscopists, and EGCs are often missed during screening endoscopy using WLI alone [ 9 – 12 ]. Table 1 shows a summary of studies on LCI for the detection of gastric neoplasms [ 15 – 17 , 27 , 28 , 46 , 50 – 69 ]. To prepare Table 1 , we identified relevant studies in the literature by searching the databases of PubMed (Fig.…”
Section: Lci For Screening Of Egcmentioning
confidence: 99%
“…Non-experts placed the biopsy mark more accurately with LCI (82.3% vs. 87.2%, P < 0.001). Non-experts were indicated to prefer LCI over WLI Khurelbaatar et al [ 67 ] 2022 Retrospective/SC 508 EGCs from 456 patients Images of EGCs LCI significantly improved visibility of EGC regardless of differences in lesion morphology, histology, location, depth of invasion, and Hp status compared with conventional WLI Ishida et al [ 28 ] 2022 Retrospective/SC 99 EGC lesions from 88 patients Videos of EGCs and gastric mucosa captured using LED and laser endoscopy LED-WLI and LED-LCI can be used to visualize EGCs with non-inferiority to Laser-WLI and Laser-LCI Haruma et al [ 68 ] 2022 RCT/MC 1502 patients (patients with a history of gastrointestinal cancer) Real-time observation The detection rate of upper gastrointestinal neoplasms tended to be higher with LCI than with WLI among patients who underwent ultra-slim endoscopy Khurelbaatar et al [ 69 ] 2022 Retrospective/SC 52 EGCs and 29 nonmalignant lesions Video including cases of EGC or gastric atrophy alone using standard and ultra-thin endoscopies Ultra-thin LCI had a higher diagnostic sensitivity and significantly higher visibility scores and color difference than standard WLI SC single-center, MC multicenter, RCT randomized controlled trial, EGC early gastric cancer, IM intestinal metaplasia, LCI linked color imaging, WLI white-light imaging, BLI blue laser imaging, LED light-emitting diode, Hp Helicobacter pylori , M-Chromo-LCI magnifying linked color imaging with indigo carmine dye, M-BLI magnifying blue laser imaging, MR map-like redness, IC indigo carmine contrast method, CI confidence interval, AIM acetic acid indigo carmine mixture Fig. 2 PRISMA 2009 flow diagram describing the selection of the studies included in our review …”
Section: Lci For Screening Of Egcmentioning
confidence: 99%
“…Using data from the LCI-further improving neoplasm detection in upper gastrointestinal (LCI-FIND) trial, a sub-analysis showed that LCI is useful in identifying neoplastic lesions of the pharynx, esophagus, and stomach when used in ultra-slim endoscopy [ 68 ]. Khurelbaatar et al [ 69 ] further demonstrated that ultra-thin LCI had a higher diagnostic sensitivity and significantly higher visibility scores and color differences than standard WLI. These results suggest that color contrast is more important than resolution for EGC identification.…”
Section: Transnasal Endoscopy With Lci In Detecting Egcmentioning
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.
“…The visibility of EGC by LCI using ultrathin endoscopes is superior to that by WLI using standard endoscopes with high resolution. Ultrathin endoscope (EG-L580NW) with LCI is also reported to have better sensitivity for EGCs than conventional endoscope (EG-L590WR) with WLI [24]. In the multicenter prospective trial, LCI is useful to identify neoplastic lesions for upper GI tract screening, even when used in ultrathin endoscopy [25].…”
Section: Painless Ultrathin Endoscopy As Screening Tool For Upper Gi ...mentioning
Background: The main therapeutic modality of early upper gastrointestinal neoplasms has shifted from surgery to endoscopic therapy. The role of endoscopy has also expanded not only for more accurate diagnosis of neoplasms but for the determination of extent and depth of neoplasms with a combination of multiple electronically modified images acquired with image-enhanced endoscopy (IEE) for assessing the feasibility of endoscopic treatment.
Summary: These IEE with or without magnifying endoscopy including narrow band imaging (NBI), blue LASER imaging (BLI) and linked color imaging (LCI) using narrow-band light, has greatly changed the diagnosis for upper gastrointestinal neoplasms. These modalities produce high color contrast between cancer and surrounding mucosa at distant views and clear visualization of surface and vessels at close-up observations. LCI shows purple color of intestinal metaplasia (IM) distinct from other inflammatory gastric mucosae and facilitates the recognition of early gastric cancers often surrounded by IM. Recently ultrathin endoscopy has provided high resolution images similar to standard-caliber endoscopy. In addition, these advanced IEEs that integrate computer-assisted artificial intelligence systems are marked and will improve our diagnostic performance for neoplasia in the future.
Key message: New IEE with sufficient brightness and color contrast has increasingly been used based on accumulated evidence for early and accurate detection of neoplastic lesions. We provide recent articles relevant to endoscopic diagnosis with IEE on esophageal, gastric and duodenal neoplasms. Endoscopic equipment that integrates artificial intelligence support system is now being introduced into routine clinical use and is expected to enhance early detection of neoplastic lesions.
“…Consequently, the Japanese Guidelines for endoscopic diagnosis of gastric cancer state that the usefulness of IEE for the detection of early gastric cancer is under discussion (Evaluation by the modified Delphi method: 8, Strength of recommendation: None, Level of evidence: D) [ 72 ]. However, in comparison between LCI and WLI for detecting gastric cancer in a RCT, the percentage of patients with gastric tumours diagnosed in the first endoscopic examination was higher with LCI than with WLI [5.5% (41/750) vs. 3.3% (25/752), p = 0.011) and the proportion with overlooked neoplasms was lower in the LCI group than in the WLI group [ 5 ], suggested that LCI may be more effective than WLI for detecting gastric cancer [ 5 , 73 , 74 ]. Also, in a meta-analysis using reports investigated the usefulness of IEE (mostly NBI), the sensitivity and specificity for the diagnosis of intestinal metaplasia were 86 and 77%, and for dysplasia/early gastric cancer these values were 90 and 83%, respectively, and showed the usefulness of IEE for detection of gastric cancer [ 75 ].…”
Section: Usefulness Of Txi For Detecting Gastrointestinal Diseasesmentioning
White light imaging (WLI) is the most common endoscopic technique used for screening of gastrointestinal diseases. However, despite the advent of a new processor that offers sufficient clear illumination and other advanced developments in endoscopic instrumentation, WLI alone is inadequate for detecting all gastrointestinal diseases with abnormalities in mucosal discoloration and morphological changes to the mucosal surface. The recent development of image-enhanced endoscopy (IEE) has dramatically improved the detection of gastrointestinal diseases. Texture and colour enhancement imaging (TXI) is a new type of IEE that enhances brightness, surface irregularities, such as elevations or depressions, and subtle colour changes. TXI with two modes, namely modes 1 and 2, can selectively enhance brightness in dark areas of an endoscopic image and subtle tissue differences such as slight morphological or colour changes while simultaneously preventing over-enhancement. Several clinical studies have investigated the efficacy of TXI for detecting and visualizing gastrointestinal diseases, including oesophageal squamous cell carcinoma (ESCC), Barret’s epithelium, gastric cancer, gastric mucosal atrophy and intestinal metaplasia. Although TXI is often more useful for detecting and visualizing gastrointestinal diseases than WLI, it remains unclear whether TXI outperforms other IEEs, such as narrow-band imaging (NBI), in similar functions, and whether the performance of TXI modes 1 and 2 are comparable. Therefore, large-scale prospective studies are needed to compare the efficacy of TXI to WLI and other IEEs for endoscopic evaluation of patients undergoing screening endoscopy. Here, we review the characteristics and efficacy of TXI for the detection and visualization of gastrointestinal diseases.
Key Messages
TXI mode 1 can improve the visibility of gastrointestinal diseases and qualitative diagnosis, especially for diseases associated with colour changes.
The enhancement of texture and brightness with TXI mode 2 enables the detection of diseases, and is ideal for use in the first screening of gastrointestinal tract.
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