Abstract
Background Linked color imaging (LCI) is a newly developed image-enhancing endoscopy technology
that provides bright endoscopic images and increases color contrast. We investigated
whether LCI improves the detection of neoplastic lesions in the right colon when compared
with high definition white-light imaging (WLI).
Methods Consecutive patients undergoing colonoscopy were randomized (1:1) after cecal intubation
into right colon inspection at first pass by LCI or by WLI. At the hepatic flexure,
the scope was reintroduced to the cecum under LCI and a second right colon inspection
was performed under WLI in previously LCI-scoped patients (LCI–WLI group) and vice
versa (WLI–LCI group). Lesions detected on first- and second-pass examinations were
used to calculate detection and miss rates, respectively. The primary outcome was
the right colon adenoma miss rate.
Results Of the 600 patients enrolled, 142 had at least one adenoma in the right colon, with
similar right colon adenoma detection rates (r-ADR) in the two groups (22.7 % in LCI–WLI
and 24.7 % in WLI–LCI). At per-polyp analysis, double inspection of the right colon
in the LCI–WLI and WLI–LCI groups resulted in an 11.8 % and 30.6 % adenoma miss rate,
respectively (P < 0.001). No significant difference in miss rate was found for advanced adenomas
or sessile serrated lesions. At per-patient analysis, at least one adenoma was identified
in the second pass only (incremental ADR) in 2 of 300 patients (0.7 %) in the LCI
– WLI group and in 13 of 300 patients (4.3 %) in the WLI – LCI group (P = 0.01).
Conclusions LCI could reduce the miss rate of neoplastic lesions in the right colon.
