The impact of linked color imaging on adenoma detection rate in colonoscopy: a systematic review and meta-analysis

Abstract

Background/aims: Colorectal cancer prevention relies on surveillance colonoscopy, with the adenoma detection rate as a key factor in examination quality. Linked color imaging (LCI) enhances lesion contrast and improves the examination performance. This systematic review and meta-analysis aimed to evaluate the effect of LCI on adenoma detection rate in adults who underwent colonoscopy.

Methods: We searched the Medline, PubMed, BIREME, LILACS, and Scientific Electronic Library Online databases for randomized controlled trials comparing the use of LCI versus white light imaging (WLI), published up to March 2023. The outcomes included lesion characteristics, number of adenomas per patient, and the additional polyp detection rate.

Results: Sixteen studies were included in the analysis, which showed that LCI was more accurate than WLI in detecting adenomas, with an increased number of adenomas detected per patient. Although LCI performed well in terms of lesion size, morphology, and location, the subgroup analyses did not reveal any statistically significant differences between LCI and WLI. The addition of LCI did not result in significant improvements in the detection of serrated lesions, and there were no differences in the withdrawal time between groups.

Conclusions: LCI has been shown to be effective in detecting colonic lesions, improving the number of adenomas detected per patient and improving polyp detection rate without negatively affecting other quality criteria in colonoscopy.

Keywords: Adenoma; Colonoscopy; Colorectal neoplasms; Diagnostic techniques and procedures.

Fig. 1.

Flowchart of study selection. RCT, randomized controlled trial.

Fig. 2.

Quantitative analysis of linked color imaging (LCI) versus white light imaging (WLI) for the primary outcome: adenoma detection rate. RR, risk ratio; CI, confidence interval.

Fig. 3.

Sensitivity analysis of linked color imaging (LCI) versus white light imaging (WLI) for adenoma detection rate. RR, risk ratio; CI, confidence interval.

Fig. 4.

Funnel plot to investigate publication bias for adenoma detection rate.

Fig. 5.

Quantitative analysis of linked color imaging (LCI) versus white light imaging (WLI) for serrated lesions. SD, standard deviation; MD, mean difference; CI, confidence interval.

Fig. 6.

Quantitative analysis of linked color imaging (LCI) versus white light imaging (WLI) for mean number of adenomas per patient. SD, standard deviation; MD, mean difference; CI, confidence interval.

Fig. 7.

Comparative exploratory subgroup analysis for morphology comparing flat and non-flat lesions. LCI, linked color imaging; WLI, white light imaging; RR, risk ratio; CI, confidence interval.

Fig. 8.

Comparative exploratory subgroup analysis for size comparing lesions ≤5 mm and >5 mm. LCI, linked color imaging; WLI, white light imaging; RR, risk ratio; CI, confidence interval.

Fig. 9.

Comparative exploratory subgroup analysis for location comparing lesions in right and left colon. LCI, linked color imaging; WLI, white light imaging; RR, risk ratio; CI, confidence interval.

Fig. 10.

Additional polyp detection rate. LCI, linked color imaging; WLI, white light imaging; RR, risk ratio; CI, confidence interval.

Fig. 11.

Withdrawal time. LCI, linked color imaging; WLI, white light imaging; SD, standard deviation; MD, mean difference; CI, confidence interval.