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

Abstract

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.

Linked Color Imaging for the Detection of Colorectal Sessile Serrated Lesions

“…For the number of SSLs per patient in 2 studies, LCI also did not increase the detection of SSLs per patient compared with WLI. 3,6 The results of the current study (which shows the superiority of LCI over WLI for SSLs detection) are not consistent with these studies, and they are not consistent with the pooled results of a meta-analysis. 2 Therefore, such differences between the results need to be explained.…”

“…In the previous studies, only one article adopted a mixed study population, 5 and the rest only included people who are intended for screening or surveillance colonoscopies. 3,4,6,7 This seems to be one of the reasons for the inconsistencies with the current findings. However, indications for colonoscopy do not appear to be a factor influencing SSLs detection in the present study.…”

“…2 Among these, several studies have reported the comparison results of LCI versus white light imaging (WLI) in the detection of colorectal sessile serrated lesions (SSLs). [3][4][5][6][7] Interestingly, we found that the results of all these studies showed no difference in the detection rate of SSLs between the 2 groups. For the number of SSLs per patient in 2 studies, LCI also did not increase the detection of SSLs per patient compared with WLI.…”

Real-time diagnostic accuracy of blue light imaging, linked color imaging and white-light endoscopy for colorectal polyp characterization

“…This prospective study is a prespecified post-hoc analysis of the LCI-LYNCH trial [13]. The study was conducted in in eight centers in Belgium, Italy, the Netherlands, Poland, Spain, and the United Kingdom.…”

Mucosal imaging in colon polyps: New advances and what the future may hold

“…In addition, a 2020 meta-analysis of 7 studies including 3097 patients demonstrated improved adenoma detection (RR 1.26, P < 0.001), particularly in the right colon (RR 2.68, P < 0.001) and a mean of 0.27 additional adenomas detected per colonoscopy[ 85 ]. In a high-risk population of patients with HNPCC, LCI was found to improve ADR compared to HD-WLI (36.3% vs 25.6%, P = 0.04)[ 86 ]. Interestingly, while advanced imaging such as NBI appears to have a greater impact when used by experienced endoscopists, a 2021 study by Hasegawa et al [ 87 ] found a strong negative correlation between the baseline ADR with HD-WLI and the improvement ratio, indicating that perhaps the familiar colour pattern allows effective use by non-expert proceduralists.…”