Background and Aims

Linked-color imaging (LCI), a new image-enhancing technology emphasizing contrast in mucosal color, has been demonstrated to substantially reduce polyp miss rate as compared with standard white-light imaging (WLI) in tandem colonoscopy studies. Whether LCI increases adenoma detection rate (ADR) remains unclear.

Methods

Consecutive subjects undergoing screening colonoscopy after fecal immunochemical test (FIT) positivity were 1:1 randomized to undergo colonoscopy with LCI or WLI, both in high-definition systems. Insertion and withdrawal phases of each colonoscopy were carried out using the same assigned light. Experienced endoscopists from 7 Italian centers participated in the study. Randomization was stratified by gender, age, and screening round. The primary outcome measure was represented by ADR.

Results

Of 704 eligible subjects, 649 were included (48.9% men, mean age ± standard deviation, 60.8 ± 7.3 years) and randomized to LCI (n = 326) or WLI (n = 323) colonoscopy. The ADR was higher in the LCI group (51.8%) than in the WLI group (43.7%) (relative risk, 1.19; 95% confidence interval, 1.01-1.40). The proportions of patients with advanced adenomas and sessile serrated lesions were, respectively, 21.2% and 8.6% in the LCI arm and 18.9% and 5.9% in the WLI arm (not significant for both comparisons). At multivariate analysis, LCI was independently associated with ADR, along with male gender, increasing age, and adequate (Boston Bowel Preparation Scale score ≥6) bowel preparation. At per-polyp analysis, the mean ± standard deviation number of adenomas per colonoscopy was comparable in the LCI and WLI arms, whereas the corresponding figures for proximal adenomas was significantly higher in the LCI group (.72 ± 1.2 vs .55 ± 1.07, P = .05)

Conclusions

In FIT-positive patients undergoing screening colonoscopy, the routine use of LCI significantly increased the ADR. (Clinical trial registration number: NCT03690297.)

中文翻译：

---

链接的彩色成像与白光结肠镜检查在有组织的大肠癌筛查程序中进行。

背景和目标

链接彩色成像（LCI）是一种新的图像增强技术，强调粘膜颜色的对比度，与串联结肠镜检查研究中的标准白光成像（WLI）相比，可显着降低息肉漏诊率。LCI是否会增加腺瘤检出率（ADR）尚不清楚。

方法

将粪便免疫化学测试（FIT）阳性后接受结肠镜检查的连续受试者随机分为1：1，在高清系统中接受LCI或WLI结肠镜检查。每个结肠镜检查的插入和撤回阶段均使用相同的指定光进行。来自意大利7个中心的经验丰富的内镜医师参加了这项研究。根据性别，年龄和筛选轮次对随机分组进行分层。主要结果指标由ADR代表。

结果

在704名合格受试者中，包括649名（48.9％男性，平均年龄±标准差，60.8±7.3岁），并随机分为LCI（n = 326）或WLI（n = 323）结肠镜检查。LCI组（51.8％）的ADR高于WLI组（43.7％）（相对风险，1.19； 95％置信区间，1.01-1.40）。晚期腺瘤和无蒂锯齿状病变患者的比例在LCI组分别为21.2％和8.6％，在WLI组为18.9％和5.9％（两个比较均无统计学意义）。在多变量分析中，LCI与ADR，男性，年龄增加和适当的（波士顿肠道准备量表评分≥6）肠道准备独立相关。在每个息肉分析中，每个结肠镜检查的腺瘤的平均±标准差数在LCI和WLI组中相当，P  = .05）

结论

在接受结肠镜检查的FIT阳性患者中，常规使用LCI可显着提高ADR。（临床试验注册号：NCT03690297。）