Linked color imaging focused on neoplasm detection in the upper gastrointestinal tract

Shoko Ono, Kenro Kawada, Osamu Dohi, Shinji Kitamura, Tomoyuki Koike, Shinichiro Hori, Hiromitsu Kanzaki, Takahisa Murao, Nobuaki Yagi, Fumisato Sasaki, Keiichi Hashiguchi, Shiro Oka, Kazuhiro Katada, Ryo Shimoda, Kazuhiro Mizukami, Mitsuhiko Suehiro, Toshihisa Takeuchi, Shinichi Katsuki, Momoko Tsuda, Yuji NaitoTatsuyuki Kawano, Ken Haruma, Hideki Ishikawa, Keita Mori, Mototsugu Kato

Research output: Contribution to journalArticlepeer-review

62 Citations (Scopus)


Background: Linked color imaging (LCI) is a new imageenhanced endoscopy technique that allows users to recognize slight differences in mucosal color. Objective: To compare the performance of LCI with white light imaging (WLI) in detecting neoplastic lesions in the upper gastrointestinal tract. Design: A controlled, multicenter trial with randomization using minimization. (University Hospital Medical Information Network Clinical Trials Registry: UMIN000023863) Setting: 16 university hospitals and 3 tertiary care hospitals in Japan. Patients: 1502 patients with known previous or current cancer of the gastrointestinal tract and undergoing surveillance for gastrointestinal cancer. Intervention: WLI followed by LCI examination (WLI group) or LCI followed by WLI examination (LCI group). Measurements: Diagnosis of 1 or more neoplastic lesions in the pharynx, esophagus, or stomach in the first examination (primary outcome) and 1 or more neoplastic lesions overlooked in the first examination (secondary outcome). Results: 752 patients were assigned to the WLI group and 750 to the LCI group. The percentage of patients with 1 or more neoplastic lesions diagnosed in the first examination was higher with LCI than with WLI (60 of 750 patients or 8.0% [95% CI, 6.2% to 10.2%] vs. 36 of 752 patients or 4.8% [CI, 3.4% to 6.6%]; risk ratio, 1.67 [CI, 1.12 to 2.50; P = 0.011]). The proportion with overlooked neoplasms was lower in the LCI group than in the WLI group (5 of 750 patients or 0.67% [CI, 0.2% to 1.6%] vs. 26 of 752 patients or 3.5% [CI, 2.3% to 5.0%]; risk ratio, 0.19 [CI, 0.07 to 0.50]). Limitation: Endoscopists were not blinded. Conclusion: LCI is more effective than WLI for detecting neoplastic lesions in the pharynx, esophagus, and stomach.

Original languageEnglish
Pages (from-to)18-24
Number of pages7
JournalAnnals of Internal Medicine
Issue number1
Publication statusPublished - Jan 1 2021

ASJC Scopus subject areas

  • Internal Medicine


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