Color-Imaging Endoscopy Improves Detection of Upper GI Cancer

M. Alexander Otto, PA, MMS

January 12, 2021

Use of linked color imaging for upper gastrointestinal tract endoscopy improves the detection of neoplasms in comparison with conventional white-light imaging, according to results from a randomized trial involving more than 1500 patients.

Linked color imaging (LCI) is an advanced illumination technique that combines white light with narrow-band short-wavelength light to enhance the contrast of red and white hues during endoscopy, making it easier to recognize subtle differences in mucosal color.

At present, LCI is available only on systems manufactured by Fujifilm (ie, the Lasereo endoscopic system marketed in Japan and the Eluxeo system in the United States and Europe). The system includes the light source and a processor and can be used with various endoscopes.

"Combined with previous studies that show the efficacy of LCI in detecting large intestinal neoplasia, our findings make a strong case for wider adoption of this modality in surveillance of the entire endoscopically accessible digestive tract," senior investigator and gastroenterologist Mototsugu Kato, MD, of the Hakodate National Hospital, Hokkaido, Japan, said in a press release.

The randomized trial was conducted at 19 Japanese hospitals by 58 expert endoscopists, all of whom were experienced with LCI.

"We need further research to confirm [LCI's] efficacy in the hands of general clinicians for upper GI screening" of an average-risk population, Kato said.

Results from the trial were published in Annals of Internal Medicine

Approached for comment, gastroenterologist Marvin Ryou, MD, director of endoscopic innovation at Brigham and Women's Hospital, Boston, Massachusetts, said that he has used Fujifilm's LCI technology mostly for polyp detection on colonoscopy and has found it useful.

LCI "has been shown to be helpful for the detection of colonic neoplasia, and this Japanese multicenter study provides additional evidence of utility in foregut neoplasm detection. I would look forward to future studies of LCI in an average-risk population," he said.

Details of the Randomized Trial

All of the trial participants had previous or current gastrointestinal cancer and were undergoing upper GI endoscopic surveillance. Patients were a little older than 70 years on average, and more than 75% were men.

The patients underwent two examinations during their endoscopy sessions, one performed with LCI, and the other with conventional white-light imaging (WLI). The endoscopy system used in the study allowed the scope to switch between the two modalities, as well as others.

Overall, 750 patients were randomly assigned to undergo LCI first and then WLI; 752 underwent WLI first and then LCI.

In both groups, lesions were most common in the stomach, followed by the esophagus and the pharynx.

Neoplastic lesions in the pharynx, esophagus, or stomach ― confirmed by histology ― were detected in 60 patients (8%) with LCI, vs 36 patients (4.8%) with WLI. This translated to a 1.67 times' higher rate of detection.

First-pass WLI missed 26 lesions that were picked up by second-pass LCI. Five lesions were missed by LCI and were subsequently detected by WLI, which translated to a greater than 80% reduction in missed lesions with LCI.

Procedure time was longer with LCI than WLI, but mean differences were less than 20 seconds.

The investigators comment that there is a possibility of overdiagnosis with both systems, but perhaps more so with LCI. Overall, WLI detected 121 lesions on first pass, 30.6% of which were neoplastic; first-pass LCI detected 185 lesions, 35.7% of which were neoplastic.

The trial was funded by Fujifilm. One investigator has received a grant and another has received research funding from Fujifilm. Ryou is a consultant for the company.

Ann Intern Med. Published online October 20, 2020. Abstract

Alexander Otto is a physician assistant with a master's degree in medical science, and an award-winning medical journalist who has worked for several major news outlets before joining Medscape, including McClatchy and Bloomberg. He is an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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