Clinical Journal of Gastroenterology

, Volume 8, Issue 6, pp 385–389 | Cite as

Linked color imaging technology facilitates early detection of flat gastric cancers

  • Hisashi Fukuda
  • Yoshimasa Miura
  • Yoshikazu Hayashi
  • Takahito Takezawa
  • Yuji Ino
  • Masahiro Okada
  • Hiroyuki OsawaEmail author
  • Alan K. Lefor
  • Hironori Yamamoto
Case Report


Conventional endoscopy can miss flat early gastric cancers (0-IIb) because they may not be visible. We treated a patient with synchronous flat early gastric cancers missed by conventional white-light endoscopy (WLE). A 74-year-old Japanese male was referred for endoscopic submucosal dissection (ESD) of a depressed-type early gastric cancer (0-IIc) on the posterior wall of the antrum. Linked color imaging (LCI) detected two flat reddish lesions (0-IIb) measuring 30 mm and 10 mm in diameter in the distal body and prepyloric area, respectively, which had not been detected by conventional WLE. LCI clearly demonstrated the line of demarcation between the malignant lesion and the surrounding mucosa without magnification. Flat early gastric cancers were suspected because both lesions had irregular surface patterns using magnifying blue laser imaging (BLI). An additional depressed lesion (0-IIc) was detected by laser WLE along the greater curvature in the antrum. Magnifying BLI suggested a malignant lesion. Histological examination of biopsy specimens revealed atypical glands in all four lesions. ESD of these lesions was performed. Pathological examination of the resected specimens confirmed well-differentiated adenocarcinoma localized to the mucosa in all four lesions. Flat early gastric cancers became clearly visible using new endoscopic technology.


Linked color imaging Flat early gastric cancer Endoscopy 



Endoscopic submucosal dissection


Linked color imaging


Blue laser imaging


Narrow band imaging


Flexible spectral imaging color enhancement


Compliance with ethical standards

Conflict of Interest:

Hiroyuki Osawa received commercial research funding from Fuji film Medical Corporation and Takeda Pharmaceutical Company Limited. Author Hironori Yamamoto has a consultant relationship in FUJIFILM Corporation and has received honoraria, grants and royalties from the company.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki. Declaration of 1964 and its later amendments.

Informed Consent:

Informed consent was obtained from all patients for inclusion in the study.


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Copyright information

© Japanese Society of Gastroenterology 2015

Authors and Affiliations

  • Hisashi Fukuda
    • 1
  • Yoshimasa Miura
    • 1
  • Yoshikazu Hayashi
    • 1
  • Takahito Takezawa
    • 1
  • Yuji Ino
    • 1
  • Masahiro Okada
    • 1
  • Hiroyuki Osawa
    • 1
    Email author
  • Alan K. 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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