Linked Color Imaging Improves Sessile Serrated Lesion Detection

Linked Color Imaging Improves Sessile Serrated Lesion Detection

Douglas K. Rex, MD, MASGE, reviewing Li J, et al. Clin Gastroenterol Hepatol 2022 Apr 3.

Linked color imaging (LCI) emphasizes red color and is available on Fujinon endoscopes (Fujifilm Corp, Tokyo, Japan). Previous studies found LCI improved adenoma detection and suggested it increased the detection of sessile serrated lesions (SSLs).

This study was powered specifically to examine SSL detection with LCI. In a parallel-group randomized trial, the detection rates of one or more SSLs were 11.3% with LCI versus 5.9% with white-light imaging. The adenoma detection rates for LCI and white-light imaging were similar at 38.5% and 33%, respectively (P=.083), but the number of adenomas per colonoscopy was higher in the LCI group.

Douglas K. Rex, MD, FASGE


LCI, like blue-light imaging (Fujifilm) and narrow-band imaging (Olympus Corp, Tokyo, Japan), improves adenoma detection. This study suggests that, for LCI, the relative gain in detection rates is higher for SSLs than adenomas and is essentially double the rate of SSL detection with white-light imaging. This is a very significant gain in detection for an important group of lesions that are more likely to be missed than conventional adenomas.

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.


Li J, Zhang D, Wei Y, et al. Colorectal sessile serrated lesion detection using linked color imaging: a multicenter, parallel randomized controlled trial. Clin Gastroenterol Hepatol 2022 Apr 3. (Epub ahead of print) (

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