The role of linked color imaging in endoscopic diagnosis of Helicobacter pylori associated gastritis

Abstract

Objective

Linked color imaging (LCI), a novel image-enhanced endoscopy, can make it easy to recognize differences in mucosal color. It may be helpful for diagnosing H. pylori associated gastritis and H. pylori infection status. We investigated whether LCI could improve the diagnostic accuracy of H. pylori associated gastritis.

Materials and methods

Upper endoscopy was performed for 100 patients using white light imaging (WLI) and LCI. During the exam, endoscopic video was recorded. It was then analyzed by four expert endoscopists. They reviewed these videos for endoscopic diagnosis of atrophic gastritis, metaplastic gastritis, nodular gastritis and H. pylori infection. Tissue biopsies with rapid urease test were done to confirm H. pylori infection status and intestinal metaplasia.

Results

Kappa values for the inter-observer variability among the four endoscopists were fair to moderate under WLI and fair to good under LCI. Sensitivity, specificity, positive predictive value and negative predictive value for diagnosing H. pylori infection using WLI were 32.4%, 93.3%, 85.2% and 53.6%, respectively, while those for LCI were 57.4%, 91.3%, 88.7% and 64.3%, respectively. Total diagnostic accuracies for diagnosing H. pylori infection using WLI/LCI were 70.8%/78.8%. The accuracy and sensitivity of LCI for diagnosing H. pylori infection were significantly higher than those of WLI (p < .001 for both). However, there were no significant differences in the accuracy, sensitivity or specificity for diagnosing metaplastic gastritis between LCI and WLI.

Conclusions

LCI has better diagnostic accuracy for H. pylori infection status than WLI.

Clinical trial registration number: KCT0003674.

Keywords:

• Linked color imaging
• Helicobacter pylori
• atrophic gastritis
• gastroscopy

Ethics approval

The study protocol was approved by the Institutional Review Board (IRB) of Hallym University School of Medicine (HDT 2018-12-002-002).

Provenance and peer review: Not commissioned.

Disclosure statement

All authors disclose no financial relationships relevant to this publication.