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

Abstract：

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.).

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Paggi S,Radaelli F,Senore C,Maselli R,Amato A,Andrisani G,Di Matteo F,Cecinato P,Grillo S,Sereni G,Sassatelli R,Manfredi G,Alicante S,Buscarini E,Canova D,Milan L,Pallini P,Iwatate M,Rondonotti E,Repici A,Hassan C

doi

10.1016/j.gie.2020.05.044

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

723-730

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(20)34379-0

journal_volume

pub_type

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