Linked Color Imaging vs White Light Imaging for Detection of Gastric Cancer Precursors

A Prospective Randomized Study of Linked Color Imaging and Conventional White Light Imaging in Gastroscopy for the Detection of Gastric Cancer Precursors

This study aims to examine the use of Linked Color Imaging in detection of gastric cancer precursors, as well as oesophageal and duodenal lesions.

Study Overview

• Status: Completed
• Conditions: Early Gastric Cancer; Barrett Esophagus
• Intervention / Treatment: Diagnostic test: Linked Color Imaging; Diagnostic test: White Light Imaging

Detailed Description

Gastric cancer is the fifth most common cause of death worldwide. Early detection and removal of gastric cancer precursors and early gastric cancer is crucial for good outcomes. However, these lesions are subtle and often missed by conventional white light imaging (WLI) endoscopy. Image enhanced endoscopy techniques have been developed to enhance the detection and characterization of gastrointestinal lesions. Narrow band imaging (NBI) is one such technique. Though widely used, its drawbacks include a limited far view as a result of the optical filter causing a dark endoscopic view. Linked color imaging (LCI) is a more recent image enhanced endoscopy technique that acquires images by using both narrow-band wavelength light and white light in an appropriate balance, enhancing slight color differences in the red region of mucosa. It has been proven to improve detection of H pylori gastritis and colorectal neoplasms. Thus far, there has been no study to determine whether the use of LCI will increase the detection rate of gastric cancer precursors and early gastric cancer compared to WLI. This study aims to determine whether LCI can increase the detection rate of gastric cancer precursors and early gastric cancer when compared to white light endoscopy, with the null hypothesis being no difference in detection rates. This study will also examine the use of LCI with magnification to predict histology findings for focal lesions seen on endoscopy, as well as the use of LCI in identifying esophageal lesions (such as Barett's esophagus) and duodenal lesions.

• Study Type: Interventional
• Enrollment (Actual): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tiing Leong Ang, MBBS; Phone Number: 67888833; Email: ang.tiing.leong@singhealth.com.sg
• Study Contact Backup: Name: Nway Nway Aye; Phone Number: 67888833; Email: nway_nway_aye@cgh.com.sg

Study Locations

• Singapore
  • Singapore, Singapore, 169608
    • Singapore General Hospital
  • Singapore, Singapore, 529889
    • Changi General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients aged 50 years and above
• Patients undergoing gastroscopy for symptom evaluation
• Patients undergoing gastroscopy for surveillance of known intestinal metaplasia

Exclusion Criteria:

• Emergent gastroscopy performed for suspected acute GI bleeding
• Patients with previous surgical/endoscopic resection in stomach
• Patients with deranged coagulation and platelet function (INR>1.5, Plt<50)
• Patients with severe comorbid illness (ASA 3 and above)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Linked Color Imaging - White Light Imaging; Participant undergoes gastroscopy via Linked Color Imaging first, then followed by White Light Imaging	Diagnostic test: Linked Color Imaging; Linked Color Imaging (LCI) is a form of image enhanced endoscopy that uses a laser endoscopic system that acquires images by simultaneously using narrow-band wavelength light and white light in an appropriate balance. This enhances slight color differences in the red region of the mucosa.; Diagnostic test: White Light Imaging; White Light Imaging (WLI) uses conventional white light that encompasses all bandwidths of light to illuminate areas of interest to obtain endoscopic images.
Other: White Light Imaging - Linked Color Imaging; Participant undergoes gastroscopy via White Light Imaging first, then followed by Linked Color Imaging	Diagnostic test: Linked Color Imaging; Linked Color Imaging (LCI) is a form of image enhanced endoscopy that uses a laser endoscopic system that acquires images by simultaneously using narrow-band wavelength light and white light in an appropriate balance. This enhances slight color differences in the red region of the mucosa.; Diagnostic test: White Light Imaging; White Light Imaging (WLI) uses conventional white light that encompasses all bandwidths of light to illuminate areas of interest to obtain endoscopic images.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference in detection rate of gastric lesions between Linked Color Imaging and White Light Imaging	Includes Intestinal Metaplasia, Gastric Adenoma, Low Grade Dysplasia, High Grade Dysplasia, Early Gastric Cancer	Immediately following the procedure
Difference in detection rate of oesophageal lesions between Linked Color Imaging and White Light Imaging	Includes Barrett's Oesophagus, Low Grade Dysplasia, High Grade Dysplasia, Early Oesophageal Cancer	Immediately following the procedure
Difference in detection rate of duodenal lesions between Linked Color Imaging and White Light Imaging	Includes Duodenal adenoma, Duodenal adenocarcinoma	Immediately following the procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sensitivity and Specificity of detection of gastric lesions	Includes Intestinal Metaplasia, Gastric Adenoma, Low Grade Dysplasia, High Grade Dysplasia, Early Gastric Cancer	Upon histological confirmation - within 2 weeks of the procedure
Sensitivity and Specificity of detection of oesophageal lesions	Includes Barrett's Oesophagus, Low Grade Dysplasia, High Grade Dysplasia, Early Oesophageal Cancer	Upon histological confirmation - within 2 weeks of the procedure
Sensitivity and Specificity of detection of duodenal lesions	Includes Duodenal adenoma, Duodenal adenocarcinoma	Upon histological confirmation - within 2 weeks of the procedure

Collaborators and Investigators

• Sponsor: Changi General Hospital
• Collaborators: Singapore General Hospital
• Investigators: Principal Investigator: Tiing Leong Ang, MBBS, Changi General Hospital

Publications and helpful links

General Publications

• Sun X, Dong T, Bi Y, Min M, Shen W, Xu Y, Liu Y. Linked color imaging application for improving the endoscopic diagnosis accuracy: a pilot study. Sci Rep. 2016 Sep 19;6:33473. doi: 10.1038/srep33473.
• Dohi O, Yagi N, Onozawa Y, Kimura-Tsuchiya R, Majima A, Kitaichi T, Horii Y, Suzuki K, Tomie A, Okayama T, Yoshida N, Kamada K, Katada K, Uchiyama K, Ishikawa T, Takagi T, Handa O, Konishi H, Naito Y, Itoh Y. Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection. Endosc Int Open. 2016 Jul;4(7):E800-5. doi: 10.1055/s-0042-109049.
• Paggi S, Mogavero G, Amato A, Rondonotti E, Andrealli A, Imperiali G, Lenoci N, Mandelli G, Terreni N, Conforti FS, Conte D, Spinzi G, Radaelli F. Linked color imaging reduces the miss rate of neoplastic lesions in the right colon: a randomized tandem colonoscopy study. Endoscopy. 2018 Apr;50(4):396-402. doi: 10.1055/a-0580-7405. Epub 2018 Mar 14.
• Yao K. The endoscopic diagnosis of early gastric cancer. Ann Gastroenterol. 2013;26(1):11-22.

Study record dates

Study Major Dates

• Study Start (Actual): March 27, 2019
• Primary Completion (Actual): October 17, 2020
• Study Completion (Actual): October 17, 2020

Study Registration Dates

• First Submitted: March 27, 2019
• First Submitted That Met QC Criteria: June 16, 2019
• First Posted (Actual): June 18, 2019

Study Record Updates

• Last Update Posted (Estimated): February 15, 2024
• Last Update Submitted That Met QC Criteria: February 13, 2024
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Stomach Diseases; Esophageal Diseases; Precancerous Conditions; Stomach Neoplasms; Barrett Esophagus
• Other Study ID Numbers: 2018/2895

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No