Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection

Osamu Dohi, Nobuaki Yagi, Yuriko Onozawa, Reiko Kimura-Tsuchiya, Atsushi Majima, Tomoko Kitaichi, Yusuke Horii, Kentaro Suzuki, Akira Tomie, Tetsuya Okayama, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiro Katada, Kazuhiko Uchiyama, Takeshi Ishikawa, Tomohisa Takagi, Osamu Handa, Hideyuki Konishi, Yuji Naito, Yoshito Itoh, Osamu Dohi, Nobuaki Yagi, Yuriko Onozawa, Reiko Kimura-Tsuchiya, Atsushi Majima, Tomoko Kitaichi, Yusuke Horii, Kentaro Suzuki, Akira Tomie, Tetsuya Okayama, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiro Katada, Kazuhiko Uchiyama, Takeshi Ishikawa, Tomohisa Takagi, Osamu Handa, Hideyuki Konishi, Yuji Naito, Yoshito Itoh

Abstract

Background and study aims: Linked color imaging (LCI) is a new image-enhanced endoscopy technique using a laser light source to enhance slight differences in mucosal color. The aim of this study was to compare the usefulness of LCI and conventional white light imaging (WLI) endoscopy for diagnosing Helicobacter pylori (H. pylori).

Patients and methods: We retrospectively analyzed images from 60 patients examined with WLI and LCI endoscopy between October 2013 and May 2014. Thirty patients had H. pylori infections, and other thirty patients tested negative for H. pylori after eradication therapy. Four endoscopists evaluated the 2 types of images to determine which was better at facilitating a diagnosis of H. pylori infection.

Results: H. pylori infection was identified with LCI by enhancing the red appearance of the fundic gland mucosa. The accuracy, sensitivity, and specificity for diagnosing H. pylori infection using WLI were 74.2 %, 81.7 %, and 66.7 %, respectively, while those for LCI were 85.8 %, 93.3 %, and 78.3 %, respectively. Thus, the accuracy and sensitivity for LCI were significantly higher than those for WLI (P = 0.002 and P = 0.011, respectively). The kappa values for the inter- and intraobserver variability among the 4 endoscopists were higher for LCI than for WLI.

Conclusions: H. pylori infection can be identified by enhancing endoscopic images of the diffuse redness of the fundic gland using LCI. LCI is a novel image-enhanced endoscopy and is more useful for diagnosing H. pylori infection than is WLI.

Conflict of interest statement

Competing interests: Yuji Naito received collaboration research funding from Fujifilm Medical Co., Ltd (J132001115, J132001139). Nobuaki Yagi and Yoshito Itoh had an affiliation with donation-founded department partially from Fujifilm Medical Co., Ltd. Fujifilm Medical Co., Ltd. had no role in the study design, conduct of the study, data collection, data interpretation or preparation of the report.

Figures

Fig. 1
Fig. 1
Linked color imaging (LCI) principle. After reallocating the acquired color information on a mucosal surface or blood vessel by simultaneously irradiating narrow-band short wavelength light and white light, LCI both expands and reduces color information so that a reddish color becomes redder and a whitish color becomes whiter. R. red; G, green; B, blue. a White light imaging. b LCI.
Fig. 2
Fig. 2
Representative images of a case of H. pylori infectious gastritis. a White light imaging (WLI); gastric body from the retroflex view. b WLI; gastric body from the antegrade view.
Fig. 3
Fig. 3
Representative images of a case of H. pylori infectious gastritis. a Linked color imaging (LCI); gastric body from the retroflex view. b LCI; gastric body from the antegrade view.
Fig. 4
Fig. 4
Representative images of a case testing negative for H. pylori infection after eradication therapy. a White light imaging (WLI); gastric body from the retroflex view. b WLI; gastric body from the antegrade view.
Fig. 5
Fig. 5
Representative images of a case testing negative for H. pylori infection after eradication therapy. a Linked color imaging (LCI); gastric body from the retroflex view. b LCI; gastric body from the antegrade view.

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