Improved adenoma detection with linked color imaging technology compared to white-light colonoscopy

Abstract

Objectives

Linked color imaging (LCI) is a new endoscopic technology that may increase colorectal adenoma detection rate (ADR) and polyp detection rate (PDR) by virtual chromoendoscopy. Aim of the present study was to evaluate the effectiveness of LCI in ADR and PDR compared to the HD white-light colonoscopy (WLC) technique.

Materials and methods

Between October 2016 and June 2018, we enrolled consecutive outpatients prospectively. Eligible patients allocated randomly to undergo HD WLC or LCI colonoscopy technique during instrument withdrawal. Each colonoscopy was performed in a single center by the same three expert endoscopists (with expertise more than 5000 colonoscopies).

Results

A total of 1278 patients underwent colonoscopy in the study period. ADR and PDR were significantly higher in the LCI group compared to the WLC group (34.4% vs. 26.8%; p = .007; and 53.3% vs 46.4%; p = .023, respectively). Similarly, the mean number of adenomas per patient (MAP) was significantly higher with the LCI than WLC (0.64 vs 0.44, respectively; p = .002). The mean age of patients at the time of colonoscopy was 51.95 years (SD = 13.861) in the LCI group and 51.96 years (SD = 14.028) in the WLC group. No significant differences observed in patient demographic characteristics (there was no difference in gender and age distribution, p = .986), quality of colonoscopy preparation and withdrawal times (WT) between the two groups (WLC and the LCI groups, 493.9 (SD: 143.5) and 514.0 (SD: 139.5) sec, respectively).

Conclusions

According to our results, LCI virtual chromoendoscopic technology was superior compared to conventional HD WLC in detecting colorectal polyps and adenomas.

Keywords:

• Colonoscopy
• linked Color Imaging (LCI)
• chromoendoscopy
• adenoma detection
• polyp detection
• quality colonoscopy

Acknowledgements

Special thanks to our colleague and English lector, Dora Horvath for the English linguistic corrections. Authors are thankful to Attila Szepes for his supportive, innovative suggestions during study preparation and even in everyday endoscopy practice, who unfortunately passed away before we could finish this manuscript.

Authors contribution

M.Sz., O.L., L.M. performed the colonoscopic examinations, M.Sz., L.O., Á.F. and L.M. performed the data collection; B.D. L., Zs. D. and L.M. drafted the manuscript. L.O., M.Sz., and L.M. enrolled participants, assigned participants randomly to different colonoscopy techniques, reviewed colonoscopy and polyp images as expert endoscopists with high experience in colonoscopies. L.M. conceived the study and consulted the concept, performed data validation, supervised the manuscript preparation and is acting as the submission’s guarantor. All authors read and approved the final manuscript.

Institutional review board statement

This study was approved by the Ethical Committee of Bacs-Kiskun County Hospital, Kecskemet (registry No: 5/17.04.26) and also registered in the trial registry: ClinicalTrials.gov (Identifier: NCT03234725). The present study was conducted according to the provisions of the World Medical Association’s Declaration of Helsinki in 1995.

Informed consent statement

Patients agreed to undergo colonoscopies and if necessary, polipectomies by written informed consent.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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Additional information

Funding

Our study was supported by a restricted medical, scientific grant of the European Union (2015 GINOP 2.1.1-15-2015-00128).

Our study was supported by a restricted medical, scientific grant of the European Union (2015 GINOP 2.1.1-15-2015-00128).