Linked color imaging and upper gastrointestinal neoplasia

Abstract

White light imaging (WLI) can sometimes miss early upper gastrointestinal (UGI) neoplasms, particularly minimal changes and flat lesions. Moreover, endoscopic diagnosis of UGI neoplasia is strongly influenced by the condition of the surrounding mucosa. Recently, image-enhanced endoscopy techniques have been developed and used in clinical practice; one of which is linked color imaging (LCI), which has an expanded color range for better recognition of slight differences in mucosal color and enables easy diagnosis and differentiation of noncancerous mucosa from carcinoma. LCI does not require magnified observation and can clearly visualize structures using an ultrathin scope; therefore, it is useful for screening and surveillance endoscopy. LCI is particularly useful for detecting gastric cancer after Helicobacter pylori eradication, which accounts for most gastric cancers currently discovered, and displays malignant areas in orange or orange-red surrounded by intestinal metaplasia in lavender. Data on the use of convolutional neural network and computer-aided diagnosis with LCI for UGI neoplasm detection are currently being collected. Further studies are needed to determine the clinical role of LCI and whether it can replace WLI.

Keywords: esophageal cancer; esophagogastroduodenoscopy; gastric cancer; image‐enhanced endoscopy; linked color imaging.