LAUSR

BACKGROUND AND AIM Linked color imaging (LCI) is useful for screening in the gastrointestinal (GI) tract; however, its true clinical benefit has not been determined. The aim of this study was to determine the objective advantage of LCI for detection of upper GI neoplasms. METHODS Nine endoscopists, including three novices, three trainees and three experts, prospectively performed eye tracking. From 30 cases of esophageal or gastric neoplasm and 30 normal cases without neoplasms, a total of 120 images, including 60 pair images of white light imaging (WLI) and LCI taken at the same positions and angles, were randomly shown for 10 s. The sensitivity of tumor detection as a primary endpoint was evaluated and sensitivities by organ, size and visual gaze pattern (VGP) were also assessed. Color differences (ΔE using CIE1976 [L* a* b* ]) between lesions and surrounding mucosa were measured and compared to detectability. RESULTS A total of 1,080 experiments were completed. The sensitivities of tumor detection in WLI and LCI were 53.7% (50.1%-56.8%) and 68.1% (64.8%-70.8%), respectively (P = 0.002). LCI provided higher sensitivity than WLI for the novice and trainee groups (novice: 42.2% (WLI) vs. 65.6% (LCI), P = 0.003, trainee: 54.4% vs.70.0%, P = 0.045). No significant correlations were found between sensitivity and VGPs. LCI significantly increased ΔE, and the diagnostic accuracy with WLI depended on ΔE. CONCLUSIONS In conclusion, LCI significantly improved sensitivity in the detection of epithelial neoplasia and enabled epithelial neoplasia detection that is not possible with the small color difference in WLI.