Abstract
Background
Early diagnosis of gastric cancer is difficult in China due to the lack of a valid method for endoscopic screening. Early gastric cancer, especially flat gastric cancer, lacks specific endoscopic features. Many cases appear to be similar to ordinary gastritis cases under normal white light endoscopy, which can lead to misdiagnosis.
Aims
In order to find a new method to improve detection rate of early gastric cancer in China, we designed a trial to validate linked color imaging (LCI) for screening of early gastric cancer in a high-risk population, as compared to white light imaging (WLI).
Method
Subjects were randomly allocated to either the LCI + WLI or WLI group and then subjected to gastroscopy and all endoscopies were made after special preparation. All endoscopists had knowledge of this experiment. The main indicator was the rate of detection of gastric neoplastic lesions. The difference in the detection rate between the two groups is reported.
Results
The detection rate was 4.31% in the WLI group and 8.01% in the LCI + WLI group. This is a difference of 3.70% with a P value < 0.001 and an OR (95% CI) of 1.934 (1.362, 2.746). The lower limit of the 95% CI was greater than 0, and the superiority margin was 1%.
Conclusion
The detection rate of gastric neoplastic lesions was higher in the LCI + WLI group than in the WLI group, LCI might be an effective method for screening early gastric cancer.
Similar content being viewed by others
Abbreviations
- LCI:
-
Linked color imaging
- IEE:
-
Image-enhanced endoscopy
- NBI:
-
Narrow-band imaging
- BLI:
-
Blue laser imaging
- WLI:
-
White light imaging
- LGIN:
-
Low-grade intraepithelial neoplasia
- HGIN:
-
High-grade intraepithelial neoplasia
References
Stewart BW, Wild CP. World cancer report 2014. Lyon: World Health Organization; 2014.
Consensus on Screening and Endoscopic Diagnosis and Treatment of Early Gastric Cancer in China; 2014.
Nieminen A, Kokkola A, Yla-Liedenpohja J, et al. Early gastric cancer: clinical characteristics and results of surgery. Dig Surg. 2009;26:378–383.
Oh HJ, Kim JS. Clinical practice guidelines for endoscope reprocessing. Clin Endosc. 2015;48:364–368.
Jang JY. The past, present, and future of image-enhanced endoscopy. Clin Endosc. 2015;48:466–475.
Lee HL, Eun CS, Lee OY, et al. When do we miss synchronous gastric neoplasms with endoscopy? Gastrointest Endosc. 2010;71:1159–1165.
Muto M, Minashi K, Yano T, et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol. 2010;28:1566–1572.
Takenaka R, Kawahara Y, Okada H, et al. Narrow-band imaging provides reliable screening for esophageal malignancy in patients with head and neck cancers. Am J Gastroenterol. 2009;104:2942–2948.
Xirouchakis E, Laoudi F, Tsartsali L, et al. Screening for gastric premalignant lesions with narrow band imaging, white light and updated Sydney protocol or both? Dig Dis Sci. 2013;58:1084–1090. https://doi.org/10.1007/s10620-012-2431-x.
Dohi O, Yagi N, Onozawa Y, et al. Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection. Endosc Int Open. 2016;4:E800–E805.
Fukuda H, Miura Y, Hayashi Y, et al. Linked color imaging technology facilitates early detection of flat gastric cancers. Clin J Gastroenterol. 2015;8:385–389.
Dohi O, Yagi N, Majima A, et al. Diagnostic ability of magnifying endoscopy with blue laser imaging for early gastric cancer: a prospective study. Gastric Cancer. 2017;20:297–303.
Osawa H, Yamamoto H, et al. Blue Laser Imaging provides excellent endoscopic images of upper gastrointestinal lesions. VideoJ Encycl GI Endosc. 2014;1:607–610.
Suzuki T, Hara T, Kitagawa Y, et al. Magnified endoscopic observation of early colorectal cancer by linked color imaging with crystal violet staining (with video). Gastrointest Endosc. 2016;84:726–729.
Sun X, Dong T, Bi Y, et al. Linked color imaging application for improving the endoscopic diagnosis accuracy: a pilot study. Sci Rep. 2016;19:33473.
Yoshifuku Y, Sanomura Y, Oka S, et al. Clinical usefulness of the vs classification system using magnifying endoscopy with blue laser imaging for early gastric cancer. Gastroenterol Res Pract; 2017:3649705.
Acknowledgment
We thank all centers for their assistance which help us to complete this study successfully.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gao, J., Zhang, X., Meng, Q. et al. Linked Color Imaging Can Improve Detection Rate of Early Gastric Cancer in a High-Risk Population: A Multi-Center Randomized Controlled Clinical Trial. Dig Dis Sci 66, 1212–1219 (2021). https://doi.org/10.1007/s10620-020-06289-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-020-06289-0