Diagnostic value of linked color imaging for detecting gastritis subtypes and precancerous lesions

To evaluate the correlation between Linked Color Imaging (LCI) and the detection of gastritis subtypes and precancerous lesions under white light endoscopy.

This retrospective observational included 198 adult patients who underwent upper gastrointestinal endoscopy at our institution between January 2022 and January 2025. Patients were divided into two groups based on endoscopic imaging modality used: the white light endoscopy (WLE) group (n = 96), in which gastric mucosal examination was performed using conventional white light endoscopy only, and the LCI group (n = 102), in which linked color imaging was used in conjunction white light observation during the examination. The primary outcome was the detection of gastritis subtypes and gastric precancerous lesions, with histopathological diagnosis serving as the reference standard. Multilevel mixed-effects logistic regression analysis was performed to evaluate the independent relationship between imaging modality and lesion detection.

Intestinal metaplasia (IM) was more frequently detected with LCI than with WLE (29.4% vs. 14.6%, P = 0.012), particularly extensive IM (17.6% vs. 5.2%, P = 0.006), corpus IM (12.7% vs. 4.2%, P = 0.031), and incomplete IM (16.7% vs. 6.3%, P = 0.022). Endoscopy-histology concordance was significantly higher in the LCI group (85.4% vs. 72.1%, P = 0.021). Gastric precancerous lesions were detected more frequently with LCI (36.3% vs. 21.9%, P = 0.026), specifically flat-type dysplasia ([13.7% vs. 3.1%, P = 0.008) and lesions ≤ 10 mm (18.6% vs. 8.3%, P = 0.035). Quantitative visibility metrics were consistently superior in LCI group (all P < 0.001). In multilevel mixed-effects logistic regression, LCI use remained a significant predictor of lesion detection (OR = 0.360, 95% CI 0.173-0.746; P = 0.006), with flat morphology, advanced age, and corpus location also independently associated with lesion detection.

LCI significantly improves the detection of atrophic gastritis, intestinal metaplasia, and gastric precancerous lesions compared with WLE, particularly for subtle, flat, and small lesions.