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CC BY-NC-ND 4.0 · Endoscopy 2024; 56(05): 376-383
DOI: 10.1055/a-2239-8145
Original article

Linked-color imaging with or without artificial intelligence for adenoma detection: a randomized trial

Kazuya Miyaguchi
1   Department of Gastroenterology, Saitama Medical University, Saitama, Japan
,
Yoshikazu Tsuzuki
1   Department of Gastroenterology, Saitama Medical University, Saitama, Japan
,
Nobutaka Hirooka
2   Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
,
Hisashi Matsumoto
2   Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
,
Hideki Ohgo
3   Department of Gastroenterology, Saitama Medical University, Saitama, Japan
,
Hidetomo Nakamoto
2   Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
,
Hiroyuki Imaeda 
1   Department of Gastroenterology, Saitama Medical University, Saitama, Japan
› Author Affiliations Clinical Trial: Registration number (trial ID): UMIN000046361, Trial registry: UMIN Japan (http://www.umin.ac.jp/english/), Type of Study: Randomized control trial
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Author commentary on Kazuya Miyaguchi et al.Endoscopy 2024; 56(05): v5-v5
DOI: 10.1055/a-2253-2990

Abstract

Background Adenoma detection rate (ADR) is an important indicator of colonoscopy quality and colorectal cancer incidence. Both linked-color imaging (LCI) with artificial intelligence (LCA) and LCI alone increase adenoma detection during colonoscopy, although it remains unclear whether one modality is superior. This study compared ADR between LCA and LCI alone, including according to endoscopists’ experience (experts and trainees) and polyp size.

Methods Patients undergoing colonoscopy for positive fecal immunochemical tests, follow-up of colon polyps, and abdominal symptoms at a single institution were randomly assigned to the LCA or LCI group. ADR, adenoma per colonoscopy (APC), cecal intubation time, withdrawal time, number of adenomas per location, and adenoma size were compared.

Results The LCA (n=400) and LCI (n=400) groups showed comparable cecal intubation and withdrawal times. The LCA group showed a significantly higher ADR (58.8% vs. 43.5%; P<0.001) and mean (95%CI) APC (1.31 [1.15 to 1.47] vs. 0.94 [0.80 to 1.07]; P<0.001), particularly in the ascending colon (0.30 [0.24 to 0.36] vs. 0.20 [0.15 to 0.25]; P=0.02). Total number of nonpolypoid-type adenomas was also significantly higher in the LCA group (0.15 [0.09 to 0.20] vs. 0.08 [0.05 to 0.10]; P=0.02). Small polyps (≤5, 6–9mm) were detected significantly more frequently in the LCA group (0.75 [0.64 to 0.86] vs. 0.48 [0.40 to 0.57], P<0.001 and 0.34 [0.26 to 0.41] vs. 0.24 [0.18 to 0.29], P=0.04, respectively). In both groups, ADR was not significantly different between experts and trainees.

Conclusions LCA was significantly superior to LCI alone in terms of ADR.

Supplementary Material



Publication History

Received: 18 May 2023

Accepted after revision: 03 January 2024

Accepted Manuscript online:
08 January 2024

Article published online:
01 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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