The topic of linked color imaging versus white-light imaging needs more rigorous research

We read with interest the article by Karsenti et al. [1], in which the authors concluded that linked color imaging (LCI) did not decrease the proximal adenoma miss rate in the right colon compared with white-light imaging (WLI). We noticed two important confounding factors that may underlie conflicting results compared with previous studies [2].

First, patient age stratification must be provided when exploring the polyp or adenoma detection rate (ADR) by colonoscopy, because ADR and polyp detection rate both show an increasing trend with age [3]. A study [3] showed a twofold increase in ADR in patients aged 45 years and above compared with that in patients aged less than 45 years [3]. Subgroup age-stratified analysis is required to validate the impact of age on the proximal adenoma miss rate.

Second, the endoscopists’ experience should be considered because this study involved 10 endoscopy units and multiple endoscopists [1]. The proximal adenoma miss rate in the WLI-first and LCI-first groups were 36.7% and 31.8%, respectively, which were higher than respective values reported in a previous study (31.1% and 20.6%) [2]. These results may indicate that baseline ADR in the daily work of endoscopists was lower than that in the previous study [2]. Although all endoscopists were experienced in the Karsenti et al. study [1], those with greater experience have reported polyp detection rates with large variations [4]. Thus, baseline ADR scores by each endoscopist should be provided to determine the proportions of high and low detectors in each group. A previous study also showed that LCI improves the ADR only when performed by low detectors [2]. In addition, a nationwide study showed that nonmodifiable endoscopic characteristics might influence colonoscopy performance [5].

Overall, we believe that the results of this trial provide important insights into primary comparisons between LCI and WLI. However, to fully understand the impact of these factors on proximal adenoma miss rate outcomes, patient age stratification and baseline ADR should be considered.

Publication History

Article published online:
27 September 2024

• References

• 1 Karsenti D, Perrod G, Perrot B. et al. Impact of linked color imaging on the proximal adenoma miss rate: a multicenter tandem randomized controlled trial (the COCORICO trial). Endoscopy 2024; 56 DOI: 10.1055/a-2324-8807. (PMID: 38740373)
• 2 Hasegawa I, Yamamura T, Suzuki H. et al. Detection of colorectal neoplasms using linked color imaging: a prospective, randomized, tandem colonoscopy trial. Clin Gastroenterol Hepatol 2021; 19: 1708-1716.e4
• 3 Karsenti D, Tharsis G, Burtin P. et al. Adenoma and advanced neoplasia detection rates increase from 45 years of age. World J Gastroenterol 2019; 25: 447-456
• 4 Sekiguchi M, Westerberg M, Ekbom A. et al. Endoscopist characteristics and polyp detection in colonoscopy: cross-sectional analyses of screening of Swedish colons. Gastroenterology 2023; 164: 293-295.e4
• 5 Nass KJ, van der Vlugt M, Elfrink AKE. et al. Case-mix adjustment to compare colonoscopy performance between endoscopy centers: a nationwide registry study. Endoscopy 2022; 54: 455-462