Clinical Endoscopy

Review

Role of linked color imaging for upper gastrointestinal disease: present and future: Sang Pyo Lee; Clin Endosc 2023;56(5):546-552. Published online June 9, 2023; DOI: https://doi.org/10.5946/ce.2023.015

Techniques for upper gastrointestinal endoscopy are advancing to facilitate lesion detection and improve prognosis. However, most early tumors in the upper gastrointestinal tract exhibit subtle color changes or morphological features that are difficult to detect using white light imaging. Linked color imaging (LCI) has been developed to overcome these shortcomings; it expands or reduces color information to clarify color differences, thereby facilitating the detection and observation of lesions. This article summarizes the characteristics of LCI and advances in LCI-related research in the upper gastrointestinal tract field.

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Kyueng-Whan Min, One-Zoong Kim
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Gwang Ha Kim
World Journal of Gastroenterology.2023; 29(43): 5800. CrossRef

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Focused Review Series: Image-Enhanced Endoscopy: Update on Clinical Practice

Clinical Applications of Linked Color Imaging and Blue Laser/Light Imaging in the Screening, Diagnosis, and Treatment of Superficial Colorectal Tumors: Taku Sakamoto, Hourin Cho, Yutaka Saito; Clin Endosc 2021;54(4):488-493. Published online July 14, 2021; DOI: https://doi.org/10.5946/ce.2021.157

Abstract PDF PubReader ePub

Considering its contribution to reducing colorectal cancer morbidity and mortality, the most important task of colonoscopy is to find all existing polyps. Moreover, the accurate detection of existing polyps determines the risk of colorectal cancer morbidity and is an important factor in deciding the appropriate surveillance program for patients. Image-enhanced endoscopy is an easy-to-use modality with improved lesion detection. Linked color imaging (LCI) and blue laser/light imaging (BLI) are useful modalities for improving colonoscopy quality. Each mode has unique optical features; therefore, their intended use differs. LCI contributes to improved polyp detection due to its brightness and high color contrast between the lesion and normal mucosa, while BLI contributes to the characterization of detected polyps by evaluating the vessel and surface patterns of detected lesions. The proper use of these observation modes allows for more efficient endoscopic diagnosis. Moreover, recent developments in artificial intelligence will soon change the clinical practice of colonoscopy and this system will provide an efficient education modality for novice endoscopists.

Citations

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Improvement of Colonoscopic Image Quality Using a New LED Endoscopic System with Specialized Noise Reduction
Naohisa Yoshida, Masahiro Okada, Yoshikazu Hayashi, Reo Kobayashi, Ken Inoue, Osamu Dohi, Yoshito Itoh, Ryohei Hirose, Lucas Cardoso, Kohei Suzuki, Tomonori Yano, Hironori Yamamoto
Diagnostics.2025; 15(12): 1569. CrossRef
Classification of image-enhanced endoscopy in colon tumors
One-Zoong Kim
Clinical Endoscopy.2025; 58(3): 337. CrossRef
Endoscopic features with associated histological and molecular alterations in serrated polyps with dysplasia: Retrospective analysis of a tertiary case series
Antonello Trecca, Raffaele Borghini, Daniela Medicina, Rachele Del Sordo, Giulio Mandelli, Antonino Bella, Giuseppe Galloro, Kuang-I Fu, Vincenzo Villanacci
Digestive and Liver Disease.2024; 56(4): 687. CrossRef
Linked-color imaging with or without artificial intelligence for adenoma detection: a randomized trial
Kazuya Miyaguchi, Yoshikazu Tsuzuki, Nobutaka Hirooka, Hisashi Matsumoto, Hideki Ohgo, Hidetomo Nakamoto, Hiroyuki Imaeda
Endoscopy.2024; 56(05): 376. CrossRef
The Diagnostic Performance of Linked Color Imaging Compared to White Light Imaging in Endoscopic Diagnosis of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis
Jae Gon Lee, In Kyung Yoo, Abdullah Ozgur Yeniova, Sang Pyo Lee
Gut and Liver.2024; 18(3): 444. CrossRef
Linked color imaging improves the diagnostic accuracy of eosinophilic esophagitis
Yasuhiko Abe, Yu Sasaki, Makoto Yagi, Naoko Mizumoto, Yusuke Onozato, Takashi Kon, Masakuni Shoji, Kazuhiro Sakuta, Takayuki Sakai, Matsuki Umehara, Minami Ito, Shuhei Nakamura, Hidemoto Tsuchida, Yoshiyuki Ueno
DEN Open.2023;[Epub] CrossRef
Comparison of LED and LASER Colonoscopy About Linked Color Imaging and Blue Laser/Light Imaging of Colorectal Tumors in a Multinational Study
Naohisa Yoshida, Peter V. Draganov, Sneha John, Helmut Neumann, Rafiz Abdul Rani, Wen-Hsin Hsu, Nilesh Fernandopulle, Kewin Tien Ho Siah, Ricardo Morgenstern, Yuri Tomita, Ken Inoue, Osamu Dohi, Ryohei Hirose, Yoshito Itoh, Takaaki Murakami, Yoshikazu Ina
Digestive Diseases and Sciences.2023; 68(10): 3943. CrossRef
Classification and endoscopic diagnosis of colorectal polyps
Ji Hyun Kim, Sung Chul Park
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Role of linked color imaging for upper gastrointestinal disease: present and future
Sang Pyo Lee
Clinical Endoscopy.2023; 56(5): 546. CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
Images of laser and light‐emitting diode colonoscopy for comparing large colorectal lesion visibility with linked color imaging and white‐light imaging
Naohisa Yoshida, Yoshikazu Hayashi, Hiroshi Kashida, Yuri Tomita, Osamu Dohi, Ken Inoue, Ryohei Hirose, Yoshito Itoh, Masahiro Okada, Shiori Yoshimoto, Toshihiro Fujinuma, Hirotsugu Sakamoto, Keijiro Sunada, Yoriaki Komeda, Ikue Sekai, Natsuki Okai, Hiron
Digestive Endoscopy.2022; 34(7): 1413. CrossRef

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Case Report

New Diagnostic Approach for Esophageal Squamous Cell Neoplasms Using Linked Color Imaging and Blue Laser Imaging Combined with Iodine Staining: Masato Tsunoda, Yoshimasa Miura, Hiroyuki Osawa, Tsevelnorov Khurelbaatar, Mio Sakaguchi, Hisashi Fukuda, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2019;52(5):497-501. Published online April 16, 2019; DOI: https://doi.org/10.5946/ce.2018.195

Abstract PDF PubReader ePub

A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale red lesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine staining demonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purple and green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o’clock position inside the iodineunstained area. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o’clock position and an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine staining produce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. This new method is useful for detailed evaluation of early flat squamous cell neoplasms.

Citations

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Position statement of the World Endoscopy Organization: Role of endoscopy in screening, diagnosis, and treatment of esophageal superficial squamous neoplasiaia
Cesare Hassan, Giulio Antonelli, Philip Wai‐yan Chiu, Fabian Emura, Kenichi Goda, Prasad G. Iyer, Sameer Al Awadhi, Abed Al Lehibi, Vitor Arantes, Herbert Burgos, Cecilio L. Cerisoli, Sanford Dawsey, Peter Draganov, David Fleischer, Fernando Fluxá, Nicola
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Zi-Xin Wang, Long-Song Li, Song Su, Jin-Ping Li, Bo Zhang, Nan-Jun Wang, Sheng-Zhen Liu, Sha-Sha Wang, Shuai Zhang, Ya-Wei Bi, Fei Gao, Qun Shao, Ning Xu, Bo-Zong Shao, Yi Yao, Fang Liu, En-Qiang Linghu, Ning-Li Chai
World Journal of Gastroenterology.2023; 29(12): 1899. CrossRef
Usefulness of linked color imaging in the early detection of superficial esophageal squamous cell carcinomas
Koki Nakamura, Yuji Urabe, Shiro Oka, Naoko Nagasaki, Naoki Yorita, Kosaku Hata, Kazuhiko Masuda, Mio Kurihara, Takahiro Kotachi, Tomoyuki Boda, Shinji Tanaka, Kazuaki Chayama
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Inter‐observer variability of experts and trainees for the diagnosis of reflux esophagitis: Comparison of linked color imaging, blue laser imaging, and white light imaging
Sang Pyo Lee, Sea Hyub Kae, Hyun Joo Jang, Dong Hee Koh, Eun Suk Jung
Journal of Digestive Diseases.2021; 22(7): 425. CrossRef

10,036 View
167 Download
4 Web of Science
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Focused Review Series: Current Status of Image-Enhanced Endoscopy (IEE)

Linked Color Imaging and Blue Laser Imaging for Upper Gastrointestinal Screening: Hiroyuki Osawa, Yoshimasa Miura, Takahito Takezawa, Yuji Ino, Tsevelnorov Khurelbaatar, Yuichi Sagara, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2018;51(6):513-526. Published online November 2, 2018; DOI: https://doi.org/10.5946/ce.2018.132

Abstract PDF PubReader ePub

White light imaging (WLI) may not reveal early upper gastrointestinal cancers. Linked color imaging (LCI) produces bright images in the distant view and is performed for the same screening indications as WLI. LCI and blue laser imaging (BLI) provide excellent visibility of gastric cancers in high color contrast with respect to the surrounding tissue. The characteristic purple and green color of metaplasias on LCI and BLI, respectively, serve to increase the contrast while visualizing gastric cancers regardless of a history of Helicobacter pylori eradication.
LCI facilitates color-based recognition of early gastric cancers of all morphological types, including flat lesions or those in an H. pylori-negative normal background mucosa as well as the diagnosis of inflamed mucosae including erosions. LCI reveals changes in mucosal color before the appearance of morphological changes in various gastric lesions. BLI is superior to LCI in the detection of early esophageal cancers and abnormal findings of microstructure and microvasculature in close-up views of upper gastrointestinal cancers. Excellent images can also be obtained with transnasal endoscopy. Using a combination of these modalities allows one to obtain images useful for establishing a diagnosis. It is important to observe esophageal cancers (brown) using BLI and gastric cancers (orange) surrounded by intestinal metaplasia (purple) and duodenal cancers (orange) by LCI.

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