Linked-color imaging improves endoscopic visibility of colorectal nongranular flat lesions

Background and Aims: As a newly developed image-enhanced endoscopy (IEE) technique, linked-color imaging (LCI) provides very bright images with enhanced color tones. With the objective of improving the detection rate of colorectal flat tumor lesions, which are difficult to detect, we examined the usefulness of LCI from the viewpoint of visibility. Methods: Fifty-three consecutive nongranular flat tumors were used in this study. Endoscopic images were acquired by white-light imaging (WLI), blue-laser imaging (BLI)-bright, and LCI modes. For each lesion, we selected 1 image each acquired by WLI, BLI-bright, and LCI modes. Six endoscopists interpreted the images. By using a previously reported visibility scale, we scored the visibility level on a scale of 1 to 4. Results: The mean (+/- standard deviation) visibility scores were 2.74 +/- 1.08 for WLI, 2.94 +/- 0.97 for BLI-bright, and 3.36 +/- 0.72 for LCI. The score was significantly higher for BLI-bright compared with WLI (P <.001) and again higher for LCI compared with BLI-bright (P <.001). When we compared between experts and trainees, the corresponding scores of experts were 2.83 +/- 1.06, 3.17 +/- 0.88, and 3.40 +/- 0.74, with a tendency similar to the scores of all endoscopists. For the trainees, there was no difference between the scores for WLI (2.65 +/- 1.10) and BLI-bright (2.71 +/- 1.00), but the score for LCI (3.31 +/- 0.69) was significantly higher than that for WLI or BLI-bright (P <.001). When only sessile serrated adenoma/polyp lesions were analyzed, LCI remained significantly higher than the other 2. Conclusions: The present findings suggest that LCI increases the visibility of colorectal flat lesions and contributes to improvement of the detection rate for these lesions.