Linked color imaging enhances endoscopic detection of sessile serrated adenoma/polyps

Daisaku Fujimoto; Naoki Muguruma; Koichi Okamoto; Yasuteru Fujino; Kaizo Kagemoto; Yasuyuki Okada; Yoshifumi Takaoka; Yasuhiro Mitsui; Shinji Kitamura; Tetsuo Kimura; Hiroshi Miyamoto; Yoshimi Bando; Tomoko Sonoda; Tetsuji Takayama

doi:10.1055/s-0043-124469

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(03): E322-E334
DOI: 10.1055/s-0043-124469

Original article

Linked color imaging enhances endoscopic detection of sessile serrated adenoma/polyps

Daisaku Fujimoto

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Naoki Muguruma

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Koichi Okamoto

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Yasuteru Fujino

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Kaizo Kagemoto

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Yasuyuki Okada

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Yoshifumi Takaoka

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Yasuhiro Mitsui

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Shinji Kitamura

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Tetsuo Kimura

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Hiroshi Miyamoto

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

,

Yoshimi Bando

²Division of Pathology, Tokushima University Hospital, Tokushima, Japan.

,

Tomoko Sonoda

³Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.

,

Tetsuji Takayama

¹Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

› Institutsangaben

Abstract

Background and study aims Although new image-enhanced endoscopy (IEE) technologies such as blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) have been developed, their utility for the detection of sessile serrated adenoma/polyps (SSA/Ps) is still unclear. This study aimed to evaluate the utility of BLI, BLI-bright, and LCI for SSA/P detection in still image examinations and in a prospective randomized controlled trial (RCT).

Patients and methods A group of 6 expert and non-expert endoscopists read 200 endoscopic still images containing SSA/P lesions using white light image (WLI), BLI, BLI-bright, and LCI. Color differences were calculated using the color space method. A prospective RCT of tandem colonoscopy with WLI and LCI was performed. Patients with SSA/P and those with a history of SSA/P that had been endoscopically removed were enrolled and randomly allocated to WLI-LCI or LCI-WLI groups. Additional endoscopic detection rates for SSA/P were compared between the 2 groups.

Results LCI showed the highest SSA/P detection rate among the 4 modes for both expert and non-expert endoscopists. The detection rate with LCI for the 6 expert endoscopists (mean 98.3 ± standard deviation 2.0 %) was significantly higher than that with WLI (86.7 ± 6.0 %, P < 0.01). Likewise, the detection rate with LCI for the 6 non-expert endoscopists (92.3 ± 2.9 %) was significantly higher than that with WLI (72.7 ± 11.5 %, P < 0.01). The color difference of SSA/P with LCI was the highest among the 4 modes, and was significantly higher than with WLI (median 15.9, (interquartile range 13.7 – 20.6) vs. 10.2, (7.6 – 14.2); P < 0.0001). In the RCT, a total of 44 patients (WLI-LCI 22 vs. LCI-WLI 22) underwent colonoscopy. The additional detection rate for SSA/P in the second inspection in the WLI-LCI group (21.6 %, 8/37) was significantly higher than in the LCI-WLI group (3.2 %, 1/31; P = 0.02). The small, flat, non-mucus and isochromatic SSA/Ps in the transverse colon were detected more frequently in the second inspection with LCI.

Conclusions LCI was the most sensitive mode for SSA/P detection among WLI, BLI, BLI-bright, and LCI in the still image examinations. Our RCT strongly suggests that LCI is superior to conventional WLI for SSA/P detection during colonoscopy. UMIN000017599.

Volltext

Referenzen

References
1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66: 7-30
2 Zauber AG, Winawer SJ, OʼBrien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
3 Heresbach D, Barrioz T, Lapalus MG. et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 2008; 40: 284-290
4 Leufkens AM, van Oijen MG, Vleggaar FP. et al. Factors influencing the miss rate of polyps in a back-to-back colonoscopy study. Endoscopy 2012; 44: 470-475
5 Singh H, Nugent Z, Demers AA. et al. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology 2010; 139: 1128-1137
6 Snover DC, Ahnen D, Burt R. et al. Serrated polyps of the colon and rectum and serrated polyposis WHO classification of tumours of the digestive system. Lyon (France): IARC; 2010: 160-165
7 Higuchi T, Sugihara K, Jass JR. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 2005; 47: 32-40
8 Kambara T, Simms LA, Whitehall VL. et al. BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum. Gut 2004; 53: 1137-1144
9 Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology 2010; 138: 2088-2100
10 IJspeert JE, van Doorn SC, van der Brug YM. et al. The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate of clinically relevant serrated polyps. Gastrointest Endosc 2015; 82: 870-877
11 Hazewinkel Y, Dekker E. Colonoscopy: basic principles and novel techniques. Nat Rev Gastroenterol Hepatol 2011; 8: 554-564
12 Yoshida N, Yagi N, Inada Y. et al. The ability of a novel blue laser imaging system for the diagnosis of colorectal polyps. Dig Endosc 2014; 26: 250-258
13 Kaneko K, Oono Y, Yano T. et al. Effect of novel bright image enhanced endoscopy using blue laser imaging (BLI). Endosc Int Open 2014; 2: E212-219
14 Okada M, Sakamoto H, Takezawa T. et al. Laterally spreading tumor of the rectum delineated by linked color imaging technology. Clin Endosc 2016; 49: 207-208
15 Fukuda H, Miura Y, Hayashi Y. et al. Linked color imaging technology facilitates early detection of flat gastric cancers. Clin J Gastroenterol 2015; 8: 385-389
16 Dohi O, Yagi N, Onozawa Y. et al. Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection. Endosc Int Open 2016; 4: E800-805
17 Sun X, Dong T, Bi Y. et al. Linked color imaging for improving the endoscopic diagnosis accuracy: a pilot study. Sci Rep 2016; 6: 33473
18 Hazewinkel Y, Tytgat KM, van Leerdam ME. et al. Narrow-band imaging for the detection of polyps in patients with serrated polyposis syndrome: a multicenter, randomized, back-to-back trial. Gastrointest Endosc 2015; 81: 531-538
19 Rex DK, Clodfelter R, Rahmani F. et al. Narrow-band imaging versus white light for the detection of proximal colon serrated lesions: a randomized, controlled trial. Gastrointest Endosc 2016; 83: 166-171
20 Ikematsu H, Sakamoto T, Togashi K. et al. Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial. Gastrointest Endosc 2017; 86: 386-394
21 Min M, Deng P, Zhang W. et al. Comparison of linked color imaging and white-light colonoscopy for detection of colorectal polyps: a multicenter, randomized, crossover trial. Gastrointest Endosc 2017; 86: 724-730
22 Kitagawa Y, Hara T, Ikebe D. et al. Magnified endoscopic observation of small depressed gastric lesions using linked color imaging with indigo carmine dye. Endoscopy 2018; 50: 142-147
23 Kuehni RG. Color-tolerance data and the tentative CIE 1976 L a b formula. J Opt Soc Am 1976; 66: 497-500
24 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation scale. Gastrointest Endosc 2010; 72: 686-692
25 Suzuki T, Hara T, Kitagawa Y. et al. Linked-color imaging improves endoscopic visibility of colorectal nongranular flat lesions. Gastrointest Endosc 2017; 86: 692-697 [Epub ahead of print]
26 Singh R, Cheong KL, Zorron ChengTao Pu L. et al. Multicenter randomised controlled trial comparing the high definition white light endoscopy and the bright narrow band imaging for colon polyps. World J Gastrointest Endosc 2017; 9: 273-281
27 Uraoka T, Higashi R, Horii J. et al. Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps. J Gastroenterol 2015; 50: 555-563
28 Postic G, Lewin D, Bickerstaff C. et al. Colonoscopic miss rates determined by direct comparison of colonoscopy with colon resection specimens. Am J Gastroenterol 2002; 97: 3182-3185
29 Ball AJ, Johal SS, Riley SA. Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon: results of a randomized controlled trial. Gastrointest Endosc 2015; 82: 488-494
30 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255