Early Detection Of Gastric Cancer Research Articles

Small molecules as potential biomarkers of early gastric cancer: A mass spectrometry imaging approach

Background and aimsEarly detection of gastric cancer is an effective way to decrease the associated mortality. Efficient methods are needed to provide more sensitive biomarkers for detection of early gastric cancer (EGC). Materials and methodsWe performed liquid extraction-electrosonic spray ionization mass spectrometry imaging and immunofluorescent staining of enzymes related to lipid synthesis on cancerous and paracancerous tissues obtained from six EGC patients and investigated the serum lipid profiles. Areas under the receiver operating characteristic curves were used to determine the diagnostic accuracy of putative biomarkers. ResultsFive lipids detected in the positive ion mode and seven in negative ion mode displayed higher relative intensities in the cancerous than the paracancerous tissues. Seven lipids detected in the positive ion mode and seven in the negative ion mode displayed lower relative intensities in the cancerous than the paracancerous regions. Phosphatidylcholine (34:3) and phosphatidylcholine (36:1) showed higher relative intensities in the cancerous than in the paracancerous tissues and showed higher relative intensities in the serum of EGC patients than healthy controls. Phosphatidylcholine (32:0) showed lower relative intensities in the cancerous than in the paracancerous tissues and lower relative intensities in the serum of EGC patients than healthy controls. The areas under the receiver operating characteristic curves of serum phosphatidylcholine (32:0) and phosphatidylcholine (34:3) for identifying EGC patients were 1.000 and 0.978, respectively. ConclusionsRegions associated with EGC showed different lipid distributions and enzyme expression from the paracancerous regions. Serum Phosphatidylcholine (32:0) and phosphatidylcholine (34:3) are potential biomarkers for discriminating between EGC patients and healthy controls.

A Single-Center Follow-Up Study of Low-Grade Gastric Intraepithelial Neoplasia and the Screening of Key Genes of Precancerous Lesions.

ObjectiveThe study aimed to summarize the morphological characteristics of low-grade gastric intraepithelial neoplasia (LGIN) and explore its outcomes and risk factors. Additionally, it aimed to screen the core different expression genes (DEGs) of high-grade gastric intraepithelial neoplasia (HGIN) using bioinformatics methods to identify biomarkers for early gastric cancer outcomes.MethodsThe clinical and pathological data of 449 patients with LGIN in the endoscopy center of the Second Hospital of Hebei Medical University from June 2013 to September 2018 were collected for retrospective analysis. The GSE130823 and GSE55696 data sets were selected from the Gene Expression Omnibus database, and the GEO2R tool was used to screen DEGs in HGIN and chronic gastritis tissue types. A DEG functional enrichment analysis was conducted using the Database for Annotation, Visualization, and Integrated Discovery. The STRING database was utilized to create a protein–protein interaction network, and the CytoHubba plug-in was used to screen the key genes of HGIN.ResultsThe incidence of LGIN increased with age, and most of the patients were aged between 45–59 years (P = 0.048). Lesions were found mainly in the cardia, mostly in people aged 60 (P < 0.05). Progression occurred in 42 of 449 patients, with a 9.4% rate of cancer development. Foci larger than 10 mm, ulcerative lesions, and an Helicobacter pylori-positive result were factors affecting the outcome of LGIN (P < 0.05). Seven core genes of HGIN were screened, including MYC, SOX2, CDX2, TBX3, KRT7, CDKN2A, and MUC5AC.ConclusionThe patients with LGIN reflected the potential for developing cancer. A magnifying gastroscope can contribute to the detection of early gastric cancer. Additionally, the MYC, CDX2, and TBX3 genes may act as specific biomarkers of HGIN.

Plasma thioredoxin reductase: a potential diagnostic biomarker for gastric cancer.

To improve the early detection of gastric cancer (GC), there is a growing need for novel and efficient biomarkers. We aimed to evaluate diagnostic value of thioredoxin reductase 1 (TXNRD1), which was found to be over expressed in various malignancies. We found that TXNRD1 has a higher expression level in GC tissues compared with adjacent normal tissues, and high TXNRD1 expression was significantly associated with poor outcomes of GC patients. Next, a total of 1446 cases were collected, with 896 cases in GC, 322 in benign gastric disease and 228 in healthy controls. We noticed plasma thioredoxin reductase (TrxR) level in GC [8.4 (7.1, 9.7) U/ml] was significantly higher than that in benign disease [6.1 (5.4, 7.2) U/ml] or healthy controls [3.7 (1.7, 5.6) U/ml]. Receiver operating characteristic analysis showed that the optimal cutoff value of TrxR activity for GC diagnosis was set at 5.75 U/ml with an area under the curve of 0.945. Moreover, a combined panel of TrxR and routine tumor markers could further elevate the diagnostic efficacy compared to a single biomarker. Finally, by measuring pre- and post-treatment TrxR activity and routine tumor markers, we found the change trend of them was broadly consistent, and plasma TrxR activity was significantly decreased in patients treated with platinum/fluorouracil-based therapy. Our findings recommend plasma TrxR activity combined with tumor markers as effective diagnostic tools for GC patients. As well, plasma TrxR has the potential to monitor therapeutic efficacy.

P-114 A seven-marker DNA methylation assay for non-invasive early detection of gastric cancer

Gastric cancer (GC) is the fifth most common and fourth most lethal cancer worldwide, with 768,793 deaths in 2020. The patients’ prognosis and survival can be significantly improved by early screening and detection. While endoscopy serves as the gold standard for GC diagnosis and provides sufficient diagnostic power for identifying GC in early stages, this invasive method is costly and of limited feasibility for screening with poor compliance in developing countries with high GC incidence and large populations, e.g., China.

LncRNA PVT1 Promotes Cell Proliferation, Invasion, and Migration and Inhibits Cell Apoptosis by Phosphorylating YAP.

Gastric cancer (GC) as a serious global health problem is a threat to human longevity. Plasmacytoma variant translocation 1 (PVT1) participates in the formation and progression of various cancers, including GC. The aim of this study is to investigate the mechanism underlying the functions of PVT1 and explore a novel target for the diagnosis and treatment of GC. Analysis of the TCGA dataset using the R software identified that the lncRNA PVT1 was greatly upregulated in GC tissues. Twenty pairs of GC and adjacent normal tissues were acquired from patients with GC, and the expression of PVT1 was evaluated using RT-qPCR. Furthermore, PVT1 expression was knocked down in GC cells using siRNA, and the GC cells were divided into control, negative control (NC), and siRNA groups. Cell proliferation ability was analyzed using Cell Counting Kit-8 (CCK8) and colony formation assays, whereas cell migration and invasion ability were investigated through wound healing and Transwell assays. Moreover, Western blotting was used to analyze the expression of Yes-associated protein (YAP) and epithelial-to-mesenchymal transition (EMT) proteins. We also found that PVT1 and YAP expressions were upregulated in the GC tissues compared with those in the adjacent nontumor tissues. Knockdown of PVT1 was found to inhibit the proliferation, invasion, and migration and promote apoptosis of GC cells. Furthermore, knockdown of PVT1 downregulated YAP and promoted phosphorylation of YAP, suggesting that PVT1 exerts actions on GC cells by targeting YAP and inhibits cell apoptosis in vitro. The EMT process was also inhibited by the knockdown of PVT1. In summary, lncRNA PVT1 facilitated cell proliferation, invasion, and migration and suppressed cell apoptosis by targeting YAP. This study suggests that the expressions of PVT1 and YAP could be used for the early detection of GC and the occurrence and development of GC could be inhibited by interfering the interaction of PVT1 and YAP, which will provide new insights for the diagnosis, treatment, and prognosis of GC.

Endoscopic treatment for early gastric cancer

Background: In Korea, the number of screening endoscopies to detect early stage gastric neoplasms has increased exponentially following the active implementation of the National Cancer Screening Program.Current Concepts: Endoscopic treatment, including endoscopic mucosal resection and endoscopic submucosal dissection, is recognized as a minimally invasive treatment method with low morbidity and mortality for gastric dysplasia or early gastric cancer. Owing to improvement in the detection of early gastric cancer and advances in techniques, cases of endoscopic resection have increased and indications have been expanded. Endoscopic resection can preserve gastric function with excellent maintenance of the patient’s quality of life, and previous studies have shown better long-term follow-up outcomes compared to those with surgery. However, the fundamental limitation of endoscopic procedures is that gastric lymph-node dissection is not possible using endoscopic resection.Discussion and Conclusion: Although the usefulness of endoscopic resection is proven for tumors with a very low risk of lymph-node metastasis, follow-up examination using endoscopy and computed tomography should be performed for at least 5 years after curative resection of early gastric cancer.

Current status of the gastric cancer screening program in Korea

Background: In 2019, gastric cancer was one of the most common cancers in Korea. As a secondary prevention strategy for gastric cancer, the cancer screening has been provided since 1999 by the National Cancer Screening Program every 2 years for adults aged ≥40 years.Current Concepts: The participation rates for gastric cancer screening program have increased from 7.4% in 2002 to 62.9% in 2019. Until 2017, either upper gastrointestinal series or endoscopy were recommended for screening method. Since 2018, endoscopy has become the preferred screening method and 89.1% of the participants underwent endoscopy in 2019. After the introduction of the screening program, the 5-year relative survival rates have markedly improved (43.9% between 1993 and 1995 vs. 77.5% between 2015 and 2019), and the proportion of early gastric cancer detection has increased (28.6% in 1995 vs. 63.6% in 2019). The risk of death from gastric cancer decreased by 47% in participants who had undergone endoscopy screening. Additionally, the gastric cancer screening program is cost-effective, and endoscopy-associated adverse events rarely occur.Discussion and Conclusion: With the implementation of the screening program, mortality due to gastric cancer has decreased owing to early detection. After the completion of ongoing clinical trials in the general population, the primary prevention strategy of Helicobacter pylori eradication should be considered to effectively reduce the incidence of gastric cancer. Further studies are also required to provide optimal screening interval according to the presence of risk factors including H. pylori infection and presence of gastric mucosal atrophy.

Improved detection of early gastric cancer with linked color imaging using an ultrathin endoscope: a video-based analysis.

Background and study aims Ultrathin endoscopy causes a minimal gag reflex and has minimal effects on cardiopulmonary function. Linked color imaging (LCI) is useful for detection of malignancies in the digestive tract. The aim of this study was to clarify whether LCI with ultrathin endoscopy facilitates detection of early gastric cancer (EGC) despite its lower resolution compared with high-resolution white light imaging (WLI) with standard endoscopy. Patients and methods This was a retrospective analysis with prospectively collected video, including consecutive 166 cases of EGC or gastric atrophy alone. Ninety seconds of screening video was collected using standard and ultrathin endoscopes with both WLI and LCI for each case. Three expert endoscopists assessed each video and the sensitivity of detecting EGC calculated. Color difference calculations were performed. Results Sensitivities using ultrathin WLI, ultrathin LCI, standard WLI, and standard LCI for the identification of cancer were 66.0 %, 80.3 %, 69.9 %, and 84.0 %, respectively. The color difference between malignant lesions and surrounding mucosa with ultrathin LCI and standard LCI were significantly higher than using ultrathin WLI or standard WLI, supported subjectively by the visibility score. Ultrathin LCI color difference and visibility score were significantly higher than standard WLI. Conclusions LCI with a low-resolution ultrathin endoscope is superior to WLI with a high-resolution standard endoscope for gastric cancer screening. This suggests that the high color contrast between EGC and the surrounding mucosa is more important than high-resolution images.

Advances in screening and detection of gastric cancer

With an estimated one million new cases and 769 000 deaths in 2020, gastric cancer is the fifth most frequent cancer and fourth leading cause of cancer death globally. Incidence rates are highest in Asia and Eastern Europe. This manuscript will review the current modalities of diagnosis, staging, and screening of gastric cancer. We will also highlight development of novel diagnostics and advancements in endoscopic detection of early gastric cancer.

Evaluation of gene expression of PLEKHS1, AADAC, and CDKN3 as novel genomic markers in gastric carcinoma.

Gastric cancer (GC) is considered lethal aggressive cancer. In Egypt, GC has a low incidence but unfortunately, it is mostly diagnosed at an advanced stage with a poor prognosis. Assessment of novel markers that can be used in the early detection of GC is an urgent need. The present study was performed to assess the association of the Pleckstrin homology domain-containing S1 (PLEKHS1)، arylacetamide deacetylase (AADAC, and Cyclin-dependent kinase inhibitor 3 (CDKN3) genes with GC and to correlate their gene expression levels with tumor stage, grade, and other clinicopathological features. The current work was performed on forty gastric tissue samples; twenty in Group 1 with GC tissues at different stages, and grades and twenty in Group 2 (control group) with non-tumorous tissue. PLEKHS1, AADAC, and CDKN3 gene expression were assessed by RT-qPCR. AADAC, CDKN3 genes were significantly (p<0.001) upregulated, while PLEKHS1 gene was significantly (p<0.001) downregulated in the GC group than the control group. AADAC gene expression exhibited a high significant (p<0.001) positive correlation with the tumor grades and the tumor stages. A high significant negative correlation between AADAC, and CDKN3 gene expression (r = -.760, p<0.001) was found. The three studied parameters showed high significant sensitivity and specificity in the prediction of the presence of GC. PLEKHS1, AADAC, and CDKN3 gene expressions were suggested to be used as diagnostic and predictive biomarkers of GC, additionally, AADAC may be used as a prognostic marker in these patients for further future confirming studies.

Endoscopy screening in high-risk populations as a strategy to improve early detection of gastric cancer in the United States

Korean Americans experience significant disparities in the incidence of gastric cancer, with five times higher incidence than non-Hispanic whites (NHWs). Although Korean Americans are diagnosed at an earlier stage than other racial/ ethnic groups in the United States, they are diagnosed at a later stage compared with those in South Korea, where &gt;70% of screening-eligible adults are adherent to the bi-annual gastric cancer screening guidelines. We conducted a pilot survey to characterize patterns of endoscopy use among Korean American and NHW gastric cancer patients.

Reconstruction and Evaluation of Co-expression Network of Genes Encoding Proteins in Gastric Cancer

Background: Gastric cancer is the second leading cause of cancer-related deaths worldwide. Computational studies of cancers facilitate understanding of the cancer development pathogenic process and lead researchers to discover efficient molecular biomarkers suitable for the prognosis or early detection of gastric cancer. In cancer systems, biology researchers seek to find the cellular mechanisms of cancer with a focus on the systemic perspective. It is not just a gene, a protein, a metabolite, or any other biological factor; it is how each of these factors works in a complex system with others and tries to look at the system behavior of each factor. Methods: In this study, 411 samples of gastric cancer and 35 samples of healthy individuals’ gene expression data were collected based on search results in the TCGA database. Then we normalized and filtered the input genes. After analyzing weighted gene co-expression networks, the resulting modules became candidates for enrichment analysis and literature review. Results: Examination of the results obtained from the reconstruction and analysis of gastric cancer weighted gene co-expression network led to the discovery of pink and blue modules. Then, the genes consisting of that module were enriched through the KEGG, EnrichR, and ToppGene databases. Some of these genes, such as DMB, CD6, CD8A, CDC45, and CDC20 are known to be involved in inflammation, cell cycle, and tissue damage in cancer, and some of these other genes are less commonly reported in scientific studies. Conclusions: We can select these candidate genes as potential biomarkers to determine the prognosis and even early detection of the clinical treatment.

AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia With Helicobacter pylori

AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia With Helicobacter pylori

Beneficial effects of endoscopic screening on gastric cancer and optimal screening interval: a population-based study.

BACKGROUND : The effectiveness of endoscopic screening on gastric cancer has not been widely investigated in China and the screening interval of repeated screening has not been determined. METHODS : In a population-based prospective study, we included 375,800 individuals, 14,670 of whom underwent endoscopic screening (2012-2018). We assessed the associations between endoscopic screening and risk of incident gastric cancer and gastric cancer-specific mortality, and examined changes in overall survival and disease-specific survival following screening. The optimal screening interval for repeated endoscopy for early detection of gastric cancer was explored. RESULTS : Ever receiving endoscopic screening significantly decreased the risk of invasive gastric cancer (age- and sex-adjusted relative risk [RR] 0.69, 95 % confidence interval [CI] 0.52-0.92) and gastric cancer-specific mortality (RR 0.33, 95 %CI 0.20-0.56), particularly for noncardia gastric cancer. Repeated screening strengthened the beneficial effect on invasive gastric cancer-specific mortality of one-time screening. Among invasive gastric cancers, screening-detected individuals had significantly better overall survival (RR 0.18, 95 %CI 0.13-0.25) and disease-specific survival (RR 0.18, 95 %CI 0.13-0.25) than unscreened individuals, particularly for those receiving repeated endoscopy. For individuals with intestinal metaplasia or low grade intraepithelial neoplasia, repeated endoscopy at an interval of < 2 years, particularly within 1 year, significantly enhanced the detection of early gastric cancer, compared with repeated screening after 2 years (P-trend = 0.02). CONCLUSION : Endoscopic screening prevented gastric cancer occurrence and death, and improved its prognosis in a population-based study. Repeated endoscopy enhanced the effectiveness. Screening interval should be based on gastric lesion severity.

Raman Spectroscopy: A Novel Technology for Gastric Cancer Diagnosis

Gastric cancer is usually diagnosed at late stage and has a high mortality rate, whereas early detection of gastric cancer could bring a better prognosis. Conventional gastric cancer diagnostic methods suffer from long diagnostic times, severe trauma, and a high rate of misdiagnosis and rely heavily on doctors’ subjective experience. Raman spectroscopy is a label-free molecular vibrational spectroscopy technique that identifies the molecular fingerprint of various samples based on the inelastic scattering of monochromatic light. Because of its advantages of non-destructive, rapid, and accurate detection, Raman spectroscopy has been widely studied for benign and malignant tumor differentiation, tumor subtype classification, and section pathology diagnosis. This paper reviews the applications of Raman spectroscopy for the in vivo and in vitro diagnosis of gastric cancer, methodology related to the spectroscopy data analysis, and presents the limitations of the technique.

Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy.

Diagnostic unsedated transnasal endoscopy (uTNE) has been proven to be a safe and well-tolerated procedure. Although its utilization in the United Kingdom (UK) is increasing, it is currently available in only a few centers. Through consideration of recent studies, we aimed to perform an updated review of the technological advances in uTNE, consider their impact on diagnostic accuracy, and to determine the role of uTNE in the COVID-19 era. Current literature has shown that the diagnostic accuracy of uTNE for identification of esophageal pathology is equivalent to conventional esophagogastroduodenoscopy (cEGD). Concerns regarding suction and biopsy size have been addressed by the introduction of TNE scopes with working channels of 2.4 mm. Advances in imaging have improved detection of early gastric cancers. The procedure is associated with less cardiac stress and reduced aerosol production; when combined with no need for sedation and improved rates of patient turnover, uTNE is an efficient and safe alternative to cEGD in the COVID-19 era. We conclude that advances in technology have improved the diagnostic accuracy of uTNE to the point where it could be considered the first line diagnostic endoscopic investigation in the majority of patients. It could also play a central role in the recovery of diagnostic endoscopic services during the COVID-19 pandemic.

An artificial intelligence-based system assisted endoscopists to detect early gastric cancer: a case report

Background: The mucosal changes of early gastric cancers (EGC) are slight and difficult to be recognized, leading to a high miss rate. Artificial intelligence (AI) systems have the potential to improve the detection of EGC. Here, we report a case of early gastric cancer discovered by an endoscopist with the assistance of an AI system. Case presentation: A 67-year-old male patient came to our hospital for Esophagogastroduodenoscopy (EGD) due to a routine physical examination. He had previously been healthy but was treated for a Helicobacter pylori infection two years ago. In the process of EGD, the AI system flagged a tiny mucosal lesion that was far away and was not detected by the endoscopist, and this lesion attracted the endoscopist&amp;#039;s additional attention. After the close observation of the lesion, the AI system immediately gave a red prompt box, suggesting that the endoscopist further observe it. Under magnifying narrow-band imaging (ME-NBI), the mucosal glands and blood vessels of the lesion were irregular, and AI diagnosed it as a suspicious gastric carcinoma. Biopsy pathology showed that it was high-grade intraepithelial neoplasia, and after endoscopic mucosal dissection (ESD), post-ESD histology confirmed that the lesion was a highly differentiated adenocarcinoma confined to the mucosa, with a lesion range of 1.1cm × 1.0cm. The patient was discharged from the hospital without any postoperative complications. Conclusion: AI has been widely applied in the field of gastrointestinal endoscopy and has the potential to help improve the detection rate of early gastrointestinal cancers. We reported a case of early gastric cancer discovered by the endoscopist with the assistance of AI.

Diagnostic efficacy of circular RNAs as noninvasive, liquid biopsy biomarkers for early detection of gastric cancer

BackgroundMajority of gastric cancers (GC) are diagnosed at advanced stages which contributes towards their poor prognosis. In view of this clinical challenge, identification of non-invasive biomarker for early diagnosis is imperative. Herein, we aimed to develop a non-invasive, liquid-biopsy based assay by using circular RNAs (circRNAs) as molecular biomarkers for early detection of GC.MethodsWe performed systematic biomarker discovery and validation of the candidate circRNAs in matched tissue specimens of GC and adjacent normal mucosa. Next, we translated the discovered circRNA based biomarker panel into serum samples in a training and validation cohort of GC patients (n = 194) and non-disease controls (n = 94) and evaluated their diagnostic performance. In addition, we measured the expression of circRNAs in serum samples of pre- and post-surgical GC patients and evaluated the specificity of circRNAs biomarker panel with respect to other gastro-intestinal (GI) malignancies.ResultsWe identified 10-circRNAs in the discovery phase with subsequent validation in a pilot cohort of GC tissue specimens. Using a training cohort of patients, we developed an 8-circRNA based risk-prediction model for the diagnosis of GC. We observed that our biomarker panel robustly discriminated GC patients from non-disease controls with an AUC of 0.87 in the training, and AUC of 0.83 in the validation cohort. Notably, the biomarker panel could robustly identify even early-stage GC patients, regardless of their tumor histology (diffuse vs. intestinal). The decreased expression of circRNAs in post-surgery serum specimens indicated their tumor-specificity and their potential source of origin in the systemic circulation.ConclusionsWe identified a panel of 8-circRNAs as non-invasive, liquid-biopsy biomarkers which might serve as potential diagnostic biomarkers for the early detection of GC.

Lesion Segmentation in Gastroscopic Images Using Generative Adversarial Networks.

The segmentation of the lesion region in gastroscopic images is highly important for the detection and treatment of early gastric cancer. This paper proposes a novel approach for gastric lesion segmentation by using generative adversarial training. First, a segmentation network is designed to generate accurate segmentation masks for gastric lesions. The proposed segmentation network adds residual blocks to the encoding and decoding path of U-Net. The cascaded dilated convolution is also added at the bottleneck of U-Net. The residual connection promotes information propagation, while dilated convolution integrates multi-scale context information. Meanwhile, a discriminator is used to distinguish the generated and real segmentation masks. The proposed discriminator is a Markov discriminator (Patch-GAN), which discriminates each [Formula: see text] matrix in the image. In the process of network training, the adversary training mechanism is used to iteratively optimize the generator and the discriminator until they converge at the same time. The experimental results show that the dice, accuracy, and recall are 86.6%, 91.9%, and 87.3%, respectively. These metrics are significantly better than the existing models, which proves the effectiveness of this method and can meet the needs of clinical diagnosis and treatment.

Usefulness of linked color imaging for the detection of obscure early gastric cancer: Multivariate analysis of 508 lesions.

Early gastric cancers (EGCs) of the elevated type or with submucosal invasion are easily found by routine endoscopy. However, most early cancers are challenging to detect because of subtle morphological or color differences from surrounding atrophic mucosa and intestinal metaplasia. Linked color imaging (LCI) enhances mucosal color difference, making it easier to detect EGCs. The aim of this study is to clarify the advantages and possible disadvantages of LCI for screening for obscure EGC. A total of 665 malignant gastric lesions resected using endoscopic submucosal dissection between January 2015 and April 2018 were retrospectively reviewed. Obviously detectable lesions were not included in the main analysis when determining the target lesion. White light imaging (WLI)/LCI images of 508 endoscopically obscure malignant lesions were included in the final analysis and evaluated by three non-expert and three expert endoscopists using visibility scores for detection and extent. The detection visibility scores using LCI were significantly higher than those using WLI regardless of lesion characteristics including location, size, histological type, depth of invasion, and Helicobacter pylori status. The detection score improved in 46.4% cases and deteriorated in 4.9% when the modality changed from WLI to LCI. A mixed-effects multivariate logistic regression analysis showed that use of LCI (odds ratio [OR] 2.57), elevated type (OR 1.92), invasion to submucosa (OR 2.18) were significantly associated with improved visibility of EGC. Linked color imaging significantly improves visibility of EGC regardless of differences in lesion morphology, histology, location, depth of invasion, and H. pylori status compared to conventional WLI.