Comparison of Linked Color Imaging and White Light Imaging Colonoscopy for Detection of Colorectal Adenoma Requiring Endoscopic Treatment: A Single-Center Randomized Controlled Trial

Background: Linked color imaging (LCI) improves detection of colorectal neoplastic lesions during colonoscopy. However, polyps <5 mm in diameter often do not require resection, and the benefits of LCI are unclear for detection of colorectal polyps >= 5 mm that are indicated for endoscopic resection in clinical practice. This randomized controlled trial compared rates of detection of adenoma polyps, stratified by size, for LCI and white light imaging (WLI).Methods: We compared ADR(5 mm-) and PDR(5 mm-), which were defined as the proportion of patients with at least one adenoma or polyp with a diameter of 5 mm or larger in the LCI and WLI groups. Moreover, we estimated ADR and PDR for diameters between 5 and 10 mm (ADR(5-9 mm), PDR(5-9 mm)) and for diameters larger than 10 mm (ADR(10 mm-), PDR(10 mm-)).Results: Data from 594 patients (LCI, n=305; WLI, n=289) were analyzed. ADR(5 mm-) and PDR(5 mm-) were significantly higher in the LCI group than in the WLI group (ADR(5 mm-): P=0.016, PDR(5 mm-): P=0.020). In the assessment of adenoma and polyp size, ADR(5-9 mm) and PDR(5-9 mm) were significantly higher in the LCI group than in the WLI group, although no significant differences were seen in ADR(10 mm-) and PDR(10 mm-) between these groups.Conclusions: Polyps >= 5 mm, which are indicated for endoscopic treatment, were more easily visualized with LCI mode than with WLI mode. The improvement in detection rate was obvious for polyps <10 mm, which are easier to miss. (J Nippon Med Sch 2023; 90: 111?120)