Linked Color Imaging Improves Neoplasia Detection

Linked Color Imaging Improves Neoplasia Detection

Prateek Sharma, MD, FASGE, reviewing Ono S, et al. Ann Intern Med 2021 Jan.

Image-enhanced endoscopy is aimed at improving the detection of neoplastic lesions in the luminal GI tract during standard white-light endoscopy (WLE). Linked color imaging (LCI) is one such virtual chromoendoscopy technique that utilizes a laser to alter the intensity of mucosa and improve recognition of otherwise subtle lesions. LCI has shown some benefit in increased detection of colorectal polyps. The authors of this study conducted a multicenter, randomized controlled trial of tandem examinations to evaluate whether there was any attributable increased detection of upper GI neoplasia by LCI compared to WLE. 

This study included 750 patients in the LCI group (LCI followed by WLE; median age, 71; 77% male) and 752 patients in the WLE group (WLE followed by LCI; median age, 72; 78% male). All patients included in the study were deemed high risk (known history of a current or previous GI cancer), and the procedures were performed by experts (performed at least 20 LCI endoscopies). The use of LCI identified more patients (8%) with neoplastic lesions than the use of WLE first (4.8%) (risk ratio, 1.67; 95% confidence interval, 1.12-2.5). The number of patients with upper GI neoplasia detected with both techniques was not different for either group (60 [LCI group] vs 65 [WLE group]; P=.63). Of the lesions detected, nearly two-thirds were in the stomach in both groups. There was no difference in procedure times for evaluation of the esophagus, but an increased procedure time was noted for the LCI group in the evaluation of the stomach. No adverse events from the procedures were reported in either of the groups.

Prateek Sharma, MD, FASGE


In a high-risk patient population, the use of LCI increased the detection of neoplasia during upper endoscopy without significantly increasing procedure times. Further studies in the general population will give us more information about its utility in routine use.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Ono S, Kawada K, Dohi O, et al. Linked color imaging focused on neoplasm detection in the upper gastrointestinal tract: a randomized trial. Ann Intern Med. 2021;174:18-24. (

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