Journal of Gastroenterology

, Volume 54, Issue 5, pp 396–406 | Cite as

Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia

  • Hisashi Fukuda
  • Yoshimasa Miura
  • Hiroyuki OsawaEmail author
  • Takahito Takezawa
  • Yuji Ino
  • Masahiro Okada
  • Tsevelnorov Khurelbaatar
  • Alan Kawarai Lefor
  • Hironori Yamamoto
Original Article—Alimentary Tract



Linked color imaging (LCI) increases the visibility of early gastric cancers, which may be associated with characteristic findings including background purple mucosae. These lesions are found in areas of chronic gastritis and surrounding mucosa. The aim of this study is to objectively characterize these lesions by color differences and color component values using LCI.


Fifty-two patients with early gastric cancer were enrolled. Color differences were calculated prospectively in malignant lesions and adjacent mucosa and compared with histological findings in resected specimens. Color component values of L*, a*, and b* were compared between purple and non-purple mucosae in areas of chronic gastritis. Based on histological findings, the accuracy of identifying gastric intestinal metaplasia was calculated.


Cancers and surrounding mucosa in 74% of lesions had similar colors using white light imaging (WLI), whereas purple mucosa surrounded part or all of cancers appearing orange–red, orange or orange–white using LCI. Greater color differences were seen using LCI compared to WLI, including flat-type cancers, leading to higher contrast. The surrounding purple mucosa corresponded histologically to intestinal metaplasia, facilitating the identification of malignant lesions. Forty lesions (83%) with purple mucosa and eight lesions (17%) with non-purple mucosa in areas of chronic gastritis were diagnosed as intestinal metaplasia by biopsy (83% accuracy). Color component values of purple mucosa differ significantly from those of non-purple mucosae.


LCI images have higher color contrast between early gastric cancers and surrounding mucosa compared to WLI. A characteristic purple color around gastric cancers using LCI represents intestinal metaplasia.


Intestinal metaplasia Gastric cancer Linked color imaging Color difference 



White light images


Linked color imaging


Compliance with ethical standards

Conflict of interest

Author HO received honoraria from Fujifilm Corporation and Fujifilm Medical Corporation. Author HY received honoraria from Fujifilm Corporation and Fujifilm Medical Corporation. Other authors declare no conflicts of interest regarding this study. The funding source had no role in the design, practice or analysis of this study.


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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Hisashi Fukuda
    • 1
  • Yoshimasa Miura
    • 1
  • Hiroyuki Osawa
    • 1
    Email author
  • Takahito Takezawa
    • 1
  • Yuji Ino
    • 1
  • Masahiro Okada
    • 1
  • Tsevelnorov Khurelbaatar
    • 1
  • Alan Kawarai Lefor
    • 2
  • Hironori Yamamoto
    • 1
  1. 1.Division of Gastroenterology, Department of MedicineJichi Medical UniversityShimotsukeJapan
  2. 2.Department of SurgeryJichi Medical UniversityShimotsukeJapan

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