Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program

Colorectal Cancer

Silvia P, et al. Gastrointest Endosc 2020.


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 (WL) 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 WL, 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 (48.9% males, mean age +SD 60.8+7.3 years) were included and randomized to LCI (n=326) or WL (n=323) colonoscopy. The ADR was higher in the LCI (51.8%) than in the WL group (43.7%) (RR, 1.19; 95% CI, 1.01-1.40). The proportions of patients with advanced adenomas and sessile serrated lesions (SSL) were 21.2% and 8.6% in LCI and 18.9% and 5.9% in WL arm, respectively (p=NS for both comparisons). At multivariate analysis, LCI was independently associated with ADR, along with male gender, increasing age and adequate (Boston Bowel Preparation Scale >6) bowel preparation. At per-polyp analysis, the mean+SD number of adenomas per colonoscopy was comparable in the LCI and WL arm, whereas the corresponding figures for proximal adenomas was significantly higher in the LCI group (0.72+1.2 vs 0.55+1.07, p=0.05) CONCLUSION: In FIT positive patients undergoing screening colonoscopy, the routine use of LCI significantly increases ADR. [ no:NCT03690297].