Abstract
Objectives We aimed to determine whether linked color imaging (LCI), a new image-enhanced endoscopy that enhances subtle differences in mucosal colors, can distinguish the border of endoscopic mucosal atrophy. Methods This study included 30 patients with atrophic gastritis. In endoscopy, we continuously took images in the same composition with both LCI and white light imaging (WLI). In each image, the color values of atrophic and nonatrophic mucosae were quantified using the International Commission on Illumination 1976 (L∗, a∗, b∗) color space. Color differences at the atrophic border, defined as Euclidean distances of color values between the atrophic and nonatrophic mucosae, were compared between WLI and LCI for the overall cohort and separately for patients with Helicobacter pylori infection status. Results We found that the color difference became significantly higher with LCI than with WLI in the overall samples of 90 points in 30 patients. LCI was 14.79 ± 6.68, and WLI was 11.06 ± 5.44 (P < 0.00001). LCI was also more effective in both of the Helicobacter pylori-infected group (P = 0.00003) and the Helicobacter pylori-eradicated group (P = 0.00002). Conclusions LCI allows clear endoscopic visualization of the atrophic border under various conditions of gastritis, regardless of Helicobacter pylori infection status.
Highlights
Since the discovery of Helicobacter pylori (H. pylori) [1], chronic gastritis has attracted attention for its symptoms and as a precursor lesion for gastric cancer
Masuyama et al reported that cancer incidence was higher among patients with advanced gastric mucosal atrophy, and most patients with synchronous or metachronous cancer presented with severe atrophy [10]
As for the other assessments, we found that, ΔE was 4.2 ± 0.53 on white light imaging (WLI), the visibility of the border was significantly improved on linked color imaging (LCI), which showed ΔE = 8.3 ± 3.05 (P = 0 0001; Figure 7)
Summary
Since the discovery of Helicobacter pylori (H. pylori) [1], chronic gastritis has attracted attention for its symptoms and as a precursor lesion for gastric cancer. Typical endoscopic findings of H. pylori-infected gastric mucosa include atrophy, diffuse redness, hyperplastic polyps, gastric xanthoma, intestinal metaplasia, enlarged folds, and nodularity [2,3,4,5,6]. Among these findings, atrophy [7, 8], nodular gastritis [9], and enlarged folds [4] are reported to be associated with gastric cancer. The progression of atrophy has been noted to correlate with the risk of developing gastric cancer. Accurate evaluation of the degree of atrophy is expected to enable prediction of current and future development of cancer
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