Endoscopy 2024; 56(04): 283-290
DOI: 10.1055/a-2204-3236
Original article

Linked-color imaging versus high definition white-light endoscopy for evaluation of post-polypectomy scars of nonpedunculated lesions: LCI-Scar study

1   Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
2   Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
1   Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
2   Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
1   Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
2   Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
Karmele Saez De Gordoa
4   Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
,
Rebeca Moreira
1   Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
,
2   Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
4   Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
Francesc Balaguer
1   Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
2   Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
1   Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
› Author Affiliations
Supported by: Asociacion Española de Gastroenterologia Beca Grupo Joven 2020
Supported by: Fundacion Sociedad Española de Endoscopia Digestiva FSEED 2018
Supported by: Beca Marató tv3 201932-30
Rio Hortega contract 2021 (Oswaldo Ortiz)
Generalitat de Catalunya. Departament de Salut. (Rebeca Moreira)
Fujifilm Europe GmbH provided research equipment on loan for this study and an unrestricted research grant for this study and had no involvement in the design, recruitment, data collection, analysis or interpretation, or writing of the manuscript.

Clinical Trial: Registration number (trial ID): NCT04899700, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective, Randomized cross-over unicenter controlled trial


Abstract

Background Detection and treatment of recurrence after piecemeal endoscopic mucosal resection of nonpedunculated colorectal polyps are crucial for avoidance of post-colonoscopy cancer. Linked-color imaging (LCI) has demonstrated improved polyp detection but has never been assessed for evaluation of post-polypectomy scars. Our aim was to compare sensitivity and negative predictive value (NPV) between LCI and white-light endoscopy (WLE) for detection of post-polypectomy recurrence.

Methods Patients undergoing surveillance colonoscopy after resection of lesions ≥15 mm were included in this prospective, single-center, randomized, crossover study. Each post-polypectomy scar underwent two examinations, one with LCI and the other with WLE, performed by two blinded endoscopists. Blue-light imaging (BLI) was then applied. A diagnosis of recurrence with a level of confidence was made for each modality and histopathology was the gold standard.

Results 129 patients with 173 scars were included. Baseline patient, lesion, and procedural characteristics were similar in both arms. Recurrence was detected in 56/173 (32.4%), with 27/56 (48.2%) adenomas and 29/56 (51.8%) serrated lesions. LCI had greater sensitivity (96.4% [95%CI 87.8%–99.5%]) versus WLE (89.3% [95%CI 78.1%–95.9%]) and greater NPV (98.1% [95%CI 93.4%–99.8%] versus 94.6% [95%CI 88.7%–98.0%]). Paired concordance between modalities was 96.0%. In discordant cases, LCI identified four true-positive cases not detected by WLE and reclassified one false-positive of WLE. WLE reclassified two false positives of LCI without any increase in recurrence detection.

Conclusions LCI was highly accurate and had greater ability than WLE to rule out recurrence on post-polypectomy scars after resection of large polyps.

Supplementary Material



Publication History

Received: 03 May 2023

Accepted after revision: 04 November 2023

Accepted Manuscript online:
06 November 2023

Article published online:
19 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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