Linked Color Imaging Detects Neoplasms in Upper GI Tract More Frequently Than White Light Imaging

neoplasm, colorectal neoplasia, adenoma
Investigators compared the efficacy of linked color imaging and white light imaging in detecting neoplastic lesions in the upper gastrointestinal tract.

Linked color imaging (LCI) was found to identify neoplastic lesions of the upper gastrointestinal (GI) tract 1.67 times more frequently than white light imaging (WLI), supporting use of LCI in clinical practice, according to findings from an imaging study published in Annals of Internal Medicine. This result “indicates that many neoplastic lesions are being overlooked by conventional white light endoscopy performed in routine clinical practice,” the study authors said.

The study population comprised 1502 patients enrolled on the trial study (University Hospital Medical Information Network Clinical Trials Registry: UMIN000023863) between November 2016 and July 2018. Patients aged 20 to 89 years with known prior or current cancer of the GI tract were included. Individuals who could not undergo biopsy or endoscopy were excluded.

Patients were randomly assigned to receive WLI followed by LCI (WLI group, n=752) or LCI followed by WLI (LCI group, n=750). Examinations were conducted by endoscopists who had performed at least 20 procedures using LCI. The primary end point was the diagnosis of 1 or more neoplastic lesions in the pharynx, esophagus, or stomach during first imaging assessment. Neoplastic lesions that were overlooked by the first imaging technique but detected in the subsequent examination were a secondary end point.

Demographic characteristics were similar between treatment arms. The median patient age was 71 years (interquartile range [IQR], 28-89) in the WLI group and 72 years (IQR, 40-89) in the LCI group. The majority of participants were men (76.8% of WLI vs 77.6% of LCI). The 2 groups had similar rates of prior surgery and current cancer and a comparable history of radiation therapy.

The proportion of patients diagnosed with a neoplastic lesion during the first assessment was higher with LCI (8.0%; 95% CI, 6.2-10.2%) than with WLI (4.8%; 95% CI, 3.4-6.6%; P =.011). The relative detection ratio was 1.67 (95% CI, 1.12-2.50; P =.011).

The proportion of patients with 1 or more overlooked lesions after the first examination was lower in the LCI group (0.7%; 95% CI, 0.2-1.6%; P <.001) than the WLI group (3.5%; 95% CI, 2.3-5.0% P <.001). The risk ratio was 0.19 (95% CI, 0.07-0.50; P <.001). Overall, the combined number of patients diagnosed with neoplastic lesions during the first and second examinations was 65 (71 lesions) in the LCI group and 60 (63 lesions) in the WLI group, with no difference between groups.

“In the present study, the capability of LCI to identify gastric cancer tended to be higher than that of WLI at all locations examined, including the pharynx, esophagus, and stomach,” the study authors said.

Regarding study limitations, the investigators noted that endoscopists were not blinded to group allocation and performed the examinations on populations “at high-risk for neoplasms,” which may have affected the neoplasm detection rate. “Further investigation is needed to determine whether this technique is similarly effective for the general population,” they concluded.

Disclosure: This study was funded by Fujifilm Corporation, the manufacturer of the Linked Color Imaging device used by the investigators. Please see the original reference for a full list of authors’ disclosures.


Ono S, Kawada K, Dohi O, et al. Linked color imaging focused on neoplasm detection in the upper gastrointestinal tract: a randomized trial. Ann Intern Med. Published online October 20, 2020. doi: 10.7326/M19-2561