Reply to Li et al.

Li et al. are correct that it is important to understand who benefits the most from adenoma detection rate (ADR) optimization devices such as linked color imaging (LCI) [1]. Patient age and endoscopist experience can have an impact on all devices, as our team has shown in two previous randomized trials on computer-assisted colonoscopy (greater benefit for lower detectors) and Endocuff Vision (greater benefit for higher detectors) [2] [3]. Those studies were conducted at single centers, meaning that we could establish the endoscopists’ baseline ADR. In our multicenter COCORICO trial, our aim was to confirm or refute the benefit of LCI in routine practice by working with endoscopists in academic and nonacademic centers across France [4]. While our results are therefore more reproducible, the diversity of the participating endoscopists made determining their baseline ADR more complex. Unfortunately, we cannot therefore evaluate the impact of LCI based on baseline ADR. However, both arms (LCI-first and white-light imaging-first) were performed by the same endoscopist and the detection level (lower or higher detector) should be reflected in both arms’ results.

When comparing patients aged below and above 45 years (or even 50 years), we did not find any significant difference in the impact of LCI on the proximal adenoma miss rate, but the groups compared were not balanced owing to the low percentage of young patients.

Ultimately, the key conclusion of our study is that we temper the benefit of LCI for adenoma detection. In fact, our results show a numerically much higher impact on sessile serrated lesion (SSL) detection (although not reaching significance), as was also found in the only meta-analysis including SSLs as the secondary objective [5].

We appear to have collectively erred in focusing on adenoma detection as the primary objective in evaluating LCI [6] [7], when LCI is more effective for SSLs.

In similar future studies, the SSL miss rate or SSL detection rate should be prioritized over the adenoma miss rate or ADR, with a consequently larger study population needed.

Publication History

Article published online:
27 September 2024

• References

• 1 Li H, Bai Y, Duan Z. The topic of linked color imaging versus white-light imaging needs more rigorous research. Endoscopy 2024; 56.
• 2 Karsenti D, Tharsis G, Perrot B. et al. Effect of real-time computer-aided detection of colorectal adenoma in routine colonoscopy (COLO-GENIUS): a single-centre randomised controlled trial. Lancet Gastroenterol Hepatol 2023; 8: 726-734 DOI: 10.1016/S2468-1253(23)00104-8. (PMID: 37269872)
• 3 Karsenti D, Tharsis G, Perrot B. et al. Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial. Gut 2020; 69: 2159-2164 DOI: 10.1136/gutjnl-2019-319565. (PMID: 32209605)
• 4 Karsenti D, Perrod G, Perrot B. et al. Impact of linked color imaging on the proximal adenoma miss rate: a multicenter tandem randomized controlled trial (the COCORICO trial). Endoscopy 2024; 56 DOI: 10.1055/a-2324-8807. (PMID: 38740373)
• 5 Sun Y, Lv XH, Zhang X. et al. Linked color imaging versus white light imaging in the diagnosis of colorectal lesions: a meta-analysis of randomized controlled trials. Therap Adv Gastroenterol 2023; 16 DOI: 10.1177/17562848231196636. (PMID: 37810280)
• 6 Shinozaki S, Kobayashi Y, Hayashi Y. et al. Colon polyp detection using linked color imaging compared to white light imaging: systematic review and meta-analysis. Dig Endosc 2020; 32: 874-881 DOI: 10.1111/den.13613. (PMID: 31869487)
• 7 Wang J, Ye C, Wu K. et al. The effect of linked color imaging for adenoma detection. A meta-analysis of randomized controlled studies. J Gastrointestin Liver Dis 2022; 31: 67-73 DOI: 10.15403/jgld-4027. (PMID: 35306544)