Characteristics of Superficial Gastric Neoplasms Detected Not by White Light Imaging but by Linked Color Imaging

Laser endoscopy has a linked color imaging (LCI) mode which has been reported to be superior to white light imaging (WLI) in detecting early gastric cancer (EGC). In this study, we retrospectively investigated the characteristics of superficial gastric neoplasms detected not by WLI but by LCI.

From April 2018 to May 2023, EGC or gastric adenoma identified by EGD was observed using LCI after WLI. The size, location, macroscopic type, color, skill level of the endoscopists, and treatment were examined for lesions detected by WLI (WLI group) and lesions detected not by WLI but by LCI (LCI group).

Eighty-eight lesions of EGCs were differentiated adenocarcinomas, 13 undifferentiated adenocarcinomas, and 28 gastric adenomas. There were 117 lesions (90.7%) in the WLI group and 12 (9.2%) in the LCI group. The mean diameter was 22.9 mm in the WLI group and 9.3 mm in the LCI group, with the latter being significantly smaller (p = 0.003). The numbers of protruding, depressed, and flat lesions were 58, 59, and 0 in the WLI group, and 7, 4, and 1 in the LCI group, respectively, indicating that more protruding lesions were detected in the LCI group (p = 0.005). After multivariate analysis, there was a significant difference in diameter only in the LCI group compared to the WLI group (odds ratio, 0.834; 95% CI, 0.728-0.956).

LCI is more useful than WLI for detecting smaller superficial gastric neoplasms.