Comparison of Linked Color Imaging and White Light Imaging Colonoscopy for Detection of Colorectal Adenoma Requiring Endoscopic Treatment: A Single-Center Randomized Controlled Trial

Abstract

Background: Linked color imaging (LCI) improves detection of colorectal neoplastic lesions during colonoscopy. However, polyps <5 mm in diameter often do not require resection, and the benefits of LCI are unclear for detection of colorectal polyps ≥5 mm that are indicated for endoscopic resection in clinical practice. This randomized controlled trial compared rates of detection of adenoma polyps, stratified by size, for LCI and white light imaging (WLI). Methods: We compared ADR(5 mm-) and PDR(5 mm-), which were defined as the proportion of patients with at least one adenoma or polyp with a diameter of 5 mm or larger in the LCI and WLI groups. Moreover, we estimated ADR and PDR for diameters between 5 and 10 mm (ADR(5-9 mm), PDR(5-9 mm)) and for diameters larger than 10 mm (ADR(10 mm-), PDR(10 mm-)). Results: Data from 594 patients (LCI, n=305; WLI, n=289) were analyzed. ADR(5 mm-) and PDR(5 mm-) were significantly higher in the LCI group than in the WLI group (ADR(5 mm-): P=0.016, PDR(5 mm-): P=0.020). In the assessment of adenoma and polyp size, ADR(5-9 mm) and PDR(5-9 mm) were significantly higher in the LCI group than in the WLI group, although no significant differences were seen in ADR(10 mm-) and PDR(10 mm-) between these groups. Conclusions: Polyps ≥5 mm, which are indicated for endoscopic treatment, were more easily visualized with LCI mode than with WLI mode. The improvement in detection rate was obvious for polyps <10 mm, which are easier to miss. (J Nippon Med Sch 2023; 90: 111―120).