Adenoma detection rate (ADR) is the most widely used marker of quality, and low rates are associated with increased rates of post-colonoscopy colorectal cancer (CRC). As a newly developed image-enhanced endoscopy technique, linked-color imaging (LCI) provides very bright images with enhanced red-color tones and has been purported to increase ADR. Some studies suggest that LCI by experienced endoscopists may be more effective at detecting adenomas than white-light imaging (WLI). However, the usefulness of screening colonoscopy with LCI by novice trainees remains unknown. We undertook a randomized trial to evaluate the detection rates of colorectal polyps and adenomas with LCI in comparison to WLI during fellowship training. All colonoscopies for CRC screening were eligible for the study. Exclusion criteria included patient age <18 or >75 years, prior colon resection, or Boston bowel preparation scale (BBPS) less than 5. Patients were randomized to either LCI or WLI in a 1:1 fashion. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), adenoma per colonoscopy (APC), polyp per colonoscopy (PPC), and withdrawal time of each trainee throughout the first year of colonoscopy training. Further, these study outcomes were compared among the first 6-month and the last 6-month period of training. During November 2018 and October 2019, 6 trainees involved CRC screening in 804 patients with a mean age of 61.7±10.9 years, and 38% were male. Three hundred fifty-two patients and 452 patients underwent colonoscopic withdrawal using LCI and WLI, respectively. Patient characteristics were comparable between both groups concerning comorbidities, antiplatelet/anticoagulant usage, indication for the colonoscopy, and BBPS (Table1). Overall independent cecal intubation rate by trainees was 86.2%, and the performance of each trainee was similar between groups. However, the withdrawal time was shorter in the LCI group (14.6±8.3 min vs. 16.7±8.0 min, p<0.01). The mean ADR was 40.1% and 43.6% in LCI and WLI, respectively (p=0.32). The PDR, APC and PPC were not significantly different between both two groups. To evaluate learning curves for the quality of screening colonoscopy, the primary and secondary outcomes were compared among the first and second 6-month periods. The analysis showed that the ADR during both periods was not significantly different between the LCI and WLI groups (Table 2). The PDR, APC, and PPC between both groups were also similar between both periods. Overall, ADR by gastroenterology trainees reached the standard ADR recommended by international guidelines. Although withdrawal times with LCI were shorter than those of WLI, colonoscopy with LCI did not facilitate ADR and had no impact on the learning curve of CRC screening by novice trainees.View Large Image Figure ViewerDownload Hi-res image Download (PPT)