Improved Detection of Intestinal Metaplasia Using LCI and BLI: A Prospective Study in Western Patients

Aims We evaluated the diagnostic accuracy (DA) of Linked Color Imaging (LCI) and Blue Laser Imaging (BLI) without magnification in detecting Intestinal Metaplasia (IM) and early gastric cancer (EGC).

Methods Prospective, single-centre study in patients≥18 years undergoing upper gastrointestinal endoscopy (UGIE) for clinical symptoms, IM follow-up, or GC screening. Initially, 271 patients were evaluated, with 101 excluded: No BLI/LCI 43(16%), prior gastrectomy 28(10%), incomplete photo-documentation/histology 11(4%), intolerance 9(3%), NBI 4(1.5%), consent refusal 4(1.5%) and UGIE contraindication 2(0.7%). Standardized photo-documentation using white light imaging (WLI), LCI, and BLI. Indicators of IM: Lavender colour sign ' whitish flat elevation on LCI and light blue crest with the white opaque substance on BLI. EGGIM was evaluated. Targeted biopsies taken from suspicious lesions with histology are considered the gold standard. The chi-square test was used. Significance set at p<0.05.

Results The 170 patients had a median age of 59 (19-94) years, 94 (55%) female. Histological IM was detected in 77 (45%). WLI suspected IM in 42 (25%), confirmed in 33 (19%). LCI and BLI suspected IM in 78 (49%) and 76 (48%), respectively, and confirmed in 64 (37%) for both. WLI, LCI, and BLI suspected EGC in 14 (8%), 19 (11%), and 16 (9%) cases, respectively, and confirmed in 6 (2%). The sensitivity, specificity, positive predictive value, negative predictive value, and DA detecting IM: WLI (43%, 90%, 79%, 66%, 69%), LCI (82%, 84%, 81%, 85%, 83%), and BLI (83%, 87%, 84%, 86%, 85%). EGGIM grading: WLI classified EGGIM-0 in 91(53%) with 31(24%) upgraded to EGGIM 1-2 by LCI and BLI. In 14 (8%) patients classified as EGGIM 3-4 by WLI, LCI, and BLI identified extensive IM (EGGIM>=5) in 8 (5%) [1] [2] [3] [4] [5] [6].

Conclusions Advanced imaging with LCI and BLI improved diagnostic accuracy in detecting IM compared to WLI.

Publication History

Article published online:
27 March 2025

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