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Linked Color Imaging Can Improve Detection Rate of Early Gastric Cancer in a High-Risk Population: A Multi-Center Randomized Controlled Clinical Trial

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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.

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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

  1. Stewart BW, Wild CP. World cancer report 2014. Lyon: World Health Organization; 2014.

    Google Scholar 

  2. Consensus on Screening and Endoscopic Diagnosis and Treatment of Early Gastric Cancer in China; 2014.

  3. Nieminen A, Kokkola A, Yla-Liedenpohja J, et al. Early gastric cancer: clinical characteristics and results of surgery. Dig Surg. 2009;26:378–383.

    Article  CAS  Google Scholar 

  4. Oh HJ, Kim JS. Clinical practice guidelines for endoscope reprocessing. Clin Endosc. 2015;48:364–368.

    Article  Google Scholar 

  5. Jang JY. The past, present, and future of image-enhanced endoscopy. Clin Endosc. 2015;48:466–475.

    Article  Google Scholar 

  6. Lee HL, Eun CS, Lee OY, et al. When do we miss synchronous gastric neoplasms with endoscopy? Gastrointest Endosc. 2010;71:1159–1165.

    Article  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

Download references

Acknowledgment

We thank all centers for their assistance which help us to complete this study successfully.

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Authors and Affiliations

  1. Department of Gastroenterology, Changhai Hospital, The Second Military University, Shanghai, China

    Jie Gao, Qianqian Meng, Zhijie Wang, Wei Qian, Luoman Zhang, Xingang Shi, Zhaoshen Li & Dong Wang

  2. Department of Gastroenterology, The Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of the PLA), Beijing, China

    Yan Liu & Min Min

  3. Endoscopy Center, Shanxi Cancer Hospital, Taiyuan, China

    Xing Chen & Haihua Chen

  4. Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Xiaofeng Zhang & Hangbin Jin

  5. Jiangsu Province Hospital of TCM and Affiliated Hospital of Nanjing University of TCM, Nanjing, China

    Shutang Han & Jun Xiao

  6. The First Affiliated Hospital of Anhui Medical University, Hefei, China

    Yalei Wang & Wei Han

  7. The First Affiliated Hospital of Nanchang University, Nanchang, China

    Zhenhua Zhu & Youxiang Chen

  8. Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China

    Yapi Lu & Shuntian Cai

  9. Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China

    Weiqing Chen & Wen Ji

  10. Affiliated Hospital of Guilin Medical University, Guilin, China

    Xuhua Xiao & Qinghua Zheng

  11. Guangdong Provincial TCM Hospital, Guangzhou, China

    Beiping Zhang & Wenbin Wu

  12. Gastroenterology Department of Xiangya Hospital, CSU, Changsha, China

    Guanghui Lian & Xiaowei Liu

  13. Zhongnan Hospital of Wuhan University, Wuhan, China

    Qiu Zhao & Min Chen

  14. Xi’an Central Hospital, Xi’an, China

    Kun Zhuang & Wangli Si

  15. Digestive Endoscopy Center, Changhai Hospital, The Second Military University, Shanghai, China

    Dong Wang

Authors
  1. Jie Gao
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  2. Xiaofeng Zhang
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  3. Qianqian Meng
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  4. Hangbin Jin
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  5. Zhenhua Zhu
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  6. Zhijie Wang
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  7. Wei Qian
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  8. Luoman Zhang
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  9. Yan Liu
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  10. Min Min
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  11. Xing Chen
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  12. Haihua Chen
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  14. Jun Xiao
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  15. Yalei Wang
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  16. Wei Han
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  17. Yapi Lu
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  18. Shuntian Cai
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  19. Weiqing Chen
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  20. Wen Ji
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  21. Xuhua Xiao
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  22. Qinghua Zheng
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  23. Beiping Zhang
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  24. Wenbin Wu
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  26. Xiaowei Liu
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  28. Min Chen
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  30. Wangli Si
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  31. Xingang Shi
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  32. Youxiang Chen
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  33. Zhaoshen Li
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  34. Dong Wang
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Corresponding author

Correspondence to Dong Wang.

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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

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  • DOI: https://doi.org/10.1007/s10620-020-06289-0

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