Linked color imaging versus narrow-band imaging for colorectal polyp detection: a prospective randomized tandem colonoscopy study

Abstract

Background and Aims: Linked-color imaging (LCI) is a newly available image enhanced endoscopy (IEE) system, which emphasizes the red mucosal color. No study has yet compared LCI with other available IEE systems.

Aim: To compare the polyp detection rates of LCI with narrow band imaging (NBI).

Methods: This is a prospective randomized tandem colonoscopy study. Eligible patients who underwent colonoscopy for symptoms or screening/surveillance were randomized in a 1:1 ratio to receive tandem colonoscopy with both colonoscope withdrawals using LCI or NBI. The primary outcome was polyp detection rate.

Results: Two hundred seventy-two patients were randomized (mean age 62 years; 48.2% male; colonoscopy for symptoms: 72.8%) with 136 in each arm. During first colonoscopy, the NBI group had significantly higher polyp detection rate (71.3% vs 55.9%; P = 0.008), serrated lesion detection rate (34.6% vs 22.1%; P = 0.02), and mean number of polyps detected (2.04 vs 1.35; P = 0.02) than the LCI group. There was also a trend of higher adenoma detection rate in the NBI group (51.5% vs 39.7% in LCI; P = 0.05). Multivariable analysis confirmed that use of NBI (adjusted OR, 1.99; 95% CI, 1.09-3.68) and withdrawal time >8 minutes (aOR, 5.11; 95% CI, 2.79-9.67) were associated with polyp detection. Overall, 20.5% of polyps and 18.1% of adenoma were missed by first colonoscopy, but there was no significant difference in the miss rates between the 2 groups.

Conclusion: NBI was significantly better than LCI for colorectal polyp detection. However, both LCI and NBI missed 20.5% of polyps.