The new image enhancement endoscopy technology makes gastrointestinal lesions "nowhere to hide"!

Linked color imaging ( LCI) is a new type of image-enhanced endoscopy technology, which has been gradually applied in clinical practice
.
A number of studies have confirmed that LCI can improve the accuracy of the diagnosis of gastrointestinal mucosal lesions by increasing the contrast between the diseased mucosa and normal mucosa under endoscopy

.

Linked color imaging ( LCI) is a new type of image-enhanced endoscopy technology, which has been gradually applied in clinical practice

Since the LCI technology was launched in China

Figure: LCI basic color characteristics ( red line dashed frame range )

Figure: LCI basic color characteristics ( red line dashed frame range )

Figure: LCI basic color changes with distance

Figure: LCI basic color changes with distance

At the same time, the color is reconfigured in the LCI mode.

After adding the red accent signal, the mucosal color contrast is enhanced, which can better identify the small color difference of the mucosal color, and further increase the detection rate of gastrointestinal lesions

At the same time, the color is reconfigured in the LCI mode.

LCI mode can be combined with white light mode to screen intragastric lesions LCI mode can be combined with white light mode to screen intragastric lesions

White light endoscopy can find most of the gastric mucosal lesions,but for some minor lesions, it is easy to miss the diagnosis

.

White light endoscopy can find most of the gastric mucosal lesions, but for some minor lesions, it is easy to miss the diagnosis

Including examination when the investigation, LCI can more quickly and accurately identify suspicious lesions, favorable to shorten the operation time

LCI helps diagnose Helicobacter pylori infection LCI helps diagnose Helicobacter pylori infection

Normal mucosa microscope permutation rule set in the white light venules,while LCI pattern set emphasized color venules and make it easier conceptobserved, so as to provide important information for diagnosis of Helicobacter pylori infection

.

Normal mucosa microscope permutation rule set in the white light venules, while LCI pattern set emphasized color venules and make it easier concept observed, so as to provide important information for diagnosis of Helicobacter pylori infection

LCI can be used to diagnose gastric mucosal intestinal metaplasia LCI can be used to diagnose gastric mucosal intestinal metaplasia

Make the tube using an ordinary white light endoscopic intestinal metaplasia were observed, butin general is difficult to quickly determine the white border intestinal metaplasia

.

Make the tube using an ordinary white light endoscopic intestinal metaplasia were observed, but in general is difficult to quickly determine the white border intestinal metaplasia
.
In the LCI mode, intestinal metaplasia was purple, also known as lavender (Lavender Purple) , " mixing Purple " (in Purple Mist , the PIM) , and red-hued color non-mucosal intestinal metaplasia significantly different, thus LCI The model can be applied to the diagnosis of intestinal metaplasia
.

LCI manifestations of intestinal metaplasia

LCI manifestations of intestinal metaplasia

White endoscopic intestinal mucosal metaplasia showed the slightly rough and pale, may be in particulate form or irregularities, the LCI by morphological observation of the lesion andto achieve dual diagnosis identify the color tone
.
Lavender diagnostic intestinal epitheliumhigher efficiency metaplasia, PB78 80% or more, but need to purple vascular submucosal presented differentiated mainly by the large identification morphology
.

White endoscopic intestinal mucosal metaplasia showed the slightly rough and pale, may be in particulate form or irregularities, the LCI by morphological observation of the lesion and to achieve dual diagnosis identify the color tone
.
Lavender diagnostic intestinal epithelium higher efficiency metaplasia, PB78 80% or more, but need to purple vascular submucosal presented differentiated mainly by the large identification morphology
.

LCI can be used to screen for early gastric cancer

LCI can be used to screen for early gastric cancer LCI can be used to screen for early gastric cancer

Gastric often occurs in the context of chronic inflammation, early gastric cancer lesions may be around masked background mucosa, even with high resolution is difficult endoscopic diagnosis off
.
LCI emphasized color different mucosal surfaces of the intestinal epithelium was observed green tone mucosa was purple, red or white tumor lesions, such early lesions is more recognizable
.

Gastric often occurs in the context of chronic inflammation, early gastric cancer lesions may be around masked background mucosa, even with high resolution is difficult endoscopic diagnosis off
.
LCI emphasized color different mucosal surfaces of the intestinal epithelium was observed green tone mucosa was purple, red or white tumor lesions, such early lesions is more recognizable
.

LCI in both observed disease while lesion morphology, with emphasis on the color of gastric mucosal lesion change
.
Initially established LCI stomach mode "CVS" endoscopic diagnosis off processes for red mucosa and have a depressed lesion proposed wherein the relevant criteria, i.
e.
LCI observed by mixing the red, yellow, or mixed, suggesting early gastric cancer ; as perilesional Observing a lavender background indicates a differentiated early gastric cancer; if a lavender background is not observed, it indicates a high possibility of an undifferentiated type
.
On the basis of color diagnosis , it is necessary to further combine the diagnostic criteria of magnifying endoscopy for microvessels and microstructures for early diagnosis of gastric cancer
.

LCI in both observed disease while lesion morphology, with emphasis on the color of gastric mucosal lesion change
.
Initially established LCI stomach mode "CVS" endoscopic diagnosis off processes for red mucosa and have a depressed lesion proposed wherein the relevant criteria, i.
e.
LCI observed by mixing the red, yellow, or mixed, suggesting early gastric cancer ; as perilesional Observing a lavender background indicates a differentiated early gastric cancer; if a lavender background is not observed, it indicates a high possibility of an undifferentiated type
.
On the basis of color diagnosis , it is necessary to further combine the diagnostic criteria of magnifying endoscopy for microvessels and microstructures for early diagnosis of gastric cancer
.

LCI may be used for sessile serrated adenoma and ( or ) polyps (SSA / P) screening

LCI may be used for sessile serrated adenoma and ( or ) polyps (SSA / P) screening LCI sessile serrated adenoma and can be used ( or ) polyps (SSA / P) screening

Colorectal polyps and SSA/P are precancerous lesions of colorectal.
Screening and removing the lesions with colonoscopy can effectively reduce the incidence of colorectal cancer
.
Studies by static image checking and prospective randomized controlled trial found LCI than white, BLI , BLI-Bright of SSA / P most sensitive detection rate, while being able to improve the expert and non-expert endoscopist SSA / P detection Rate
.

Colorectal polyps and SSA/P are precancerous lesions of colorectal.
Screening and removing the lesions with colonoscopy can effectively reduce the incidence of colorectal cancer
.
Studies by static image checking and prospective randomized controlled trial found LCI than white, BLI , BLI-Bright of SSA / P most sensitive detection rate, while being able to improve the expert and non-expert endoscopist SSA / P detection Rate
.

Figure: Comparison of polyps found in white light and LCI mode

Figure: Comparison of polyps found in white light and LCI mode

For the endoscopic scoring of ulcerative colitis (UC) , the LCI classification system was established to evaluate the healing degree of UC colonic mucosa and predict the recurrence rate

For the endoscopic scoring of ulcerative colitis (UC) , the LCI classification system was established to evaluate the healing degree of UC colonic mucosa and predict the recurrence rate .
For the endoscopic score of ulcerative colitis (UC) , the LCI classification system was established for Assess the healing degree of UC colonic mucosa and predict the recurrence rate

Evaluating the healing degree of UC colonic mucosa under endoscopy is an important basis for judging the degree of UC activity, treatment goals, prognosis and clinical treatment endpoints
.
At present, the judgment of UC mucosal healing is mainly through traditional white light endoscopy, and the quality of mucosal healing under endoscopy can be used as the main predictive factor for evaluating UC recurrence
.

Evaluating the healing degree of UC colonic mucosa under endoscopy is an important basis for judging the degree of UC activity, treatment goals, prognosis and clinical treatment endpoints
.
At present, the judgment of UC mucosal healing is mainly through traditional white light endoscopy, and the quality of mucosal healing under endoscopy can be used as the main predictive factor for evaluating UC recurrence
.

In LCI mode, the histopathology of colon polyps can be predicted by referring to the NICE classification system

In LCI mode, the NICE classification system can be used to predict the histopathology of colon polyps.
In the LCI mode, the NICE classification system can be used to predict the histopathology of colon polyps.

At present, for colon polyps endoscopy at typing, NICE classification system is widely used in clinical practice
.
Studies retrospective analysis, in LCI mode can be referred to NICE type of 43 is pathologically colon polyps in patients with type predict found neoplastic lesions predicted sensitivity, specificity, positive predictive measurement values and negative predictive values were They are 96.
5% , 83.
8% , 90.
2% and 93.
9%
.

At present, for colon polyps endoscopy at typing, NICE classification system is widely used in clinical practice
.
Studies retrospective analysis, in LCI mode can be referred to NICE type of 43 is pathologically colon polyps in patients with type predict found neoplastic lesions predicted sensitivity, specificity, positive predictive measurement values and negative predictive values were They are 96.
5% , 83.
8% , 90.
2% and 93.
9%
.

Perform submucosal local injection before colonic polyp resection in LCI mode to avoid accidental injury to blood vessels

In LCI mode, perform submucosal local injection before colonic polypectomy to avoid accidental injury to blood vessels.
In LCI mode, perform submucosal local injection before colonic polypectomy to avoid accidental injury to blood vessels.

Submucosal local injection is a key step in endoscopic high-frequency resection of colon polyps and endoscopic mucosal resection (EMR) , and it is also the basis for subsequent operations
.
Suitable lower when the mucosal injection can improve the effectiveness, safety of endoscopic therapy
.
However, in the submucosal injection process, if the damage is not visible white superficial blood vessels may lead to hematoma formation, to increase the subsequent cutting difficulties in addition
.
LCI and white, the NBI technology compared, it can be more clear clarity to show vascular mucosal surface, help pinpoint injection safety position, so as to avoid damage to the surrounding blood vessel lesion, prevent having to bleeding and hematoma formation
.

Submucosal local injection is a key step in endoscopic high-frequency resection of colon polyps and endoscopic mucosal resection (EMR) , and it is also the basis for subsequent operations
.
Suitable lower when the mucosal injection can improve the effectiveness, safety of endoscopic therapy
.
However, in the submucosal injection process, if the damage is not visible white superficial blood vessels may lead to hematoma formation, to increase the subsequent cutting difficulties in addition
.
LCI and white, the NBI technology compared, it can be more clear clarity to show vascular mucosal surface, help pinpoint injection safety position, so as to avoid damage to the surrounding blood vessel lesion, prevent having to bleeding and hematoma formation
.

The LCI pattern determines the boundary of the lateral developmental adenoma (LST) of the large intestine

LCI mode determination laterally spreading adenomas (the LST) LCI mode determining laterally spreading adenomas (the LST) (the LST) lesion boundary lesion boundary

LST has a high cancer potential.
Because it develops laterally along the colonic mucosa rather than vertically, even if cancer occurs, the probability of vascular invasion and lymph node metastasis is low, and most of them are intramucosal cancers, infiltrating deep.
It was relatively small
.
As most of the LST diameter greater than 2 cm , endoscopic accurate judgment off the border to ensure complete resection of the lesion is significant
.
Further, not recommended LCI for colorectal mucosal lesions sticky mode lower membrane dissection, the recommended application LCI mode Postoperative wound, prevention of bleeding and hemostasis
.

LST has a high cancer potential.
Because it develops laterally along the colonic mucosa rather than vertically, even if cancer occurs, the probability of vascular invasion and lymph node metastasis is low, and most of them are intramucosal cancers, infiltrating deep.
It was relatively small
.
As most of the LST diameter greater than 2 cm , endoscopic accurate judgment off the border to ensure complete resection of the lesion is significant
.
Further, not recommended LCI for colorectal mucosal lesions sticky mode lower membrane dissection, the recommended application LCI mode Postoperative wound, prevention of bleeding and hemostasis
.

Original source

Original source

1 , Xie Congying , Liu Yan .
The principle and clinical application status of linkage imaging endoscopy [J].
Chinese Journal of Digestive Endoscopy , 2017, 34(8): 600-602.

1 , Xie Congying , Liu Yan .
The principle and current status of clinical application of linkage imaging endoscopy [J].
Chinese Journal of Digestive Endoscopy , 2017, 34(8): 600-602.
1 , Xie Congying , Liu Yan .
Linkage imaging endoscopy principles and clinical application .
[J] Chinese Journal of digestive Endoscopy , 2017, 34 (8): 600-602.

2 , Osawa H, Miura Y, Takezawa T, et al.
Linked color imaging and blue laser imaging for upper gastrointestinal screening[ J].
Clin Endosc, 2018, 51(6): 513-526.

2 , Osawa H, Miura Y, Takezawa T, et al.
Linked color imaging and blue laser imaging for upper gastrointestinal screening[ J].
Clin Endosc, 2018, 51(6): 513-526.
2 , Osawa H, Miura Y , Takezawa T, et al.
Linked color imaging and blue laser imaging for upper gastrointestinal screening[ J].
Clin Endosc, 2018, 51(6): 513-526.

3 , the National Center for Prevention Alliance of gastrointestinal cancer .
Digestive Endoscopy linkage recommend imaging techniques in clinical application .
Chinese Journal of Internal Medicine .
2019 in 3 Yue .

3 , the National Center for Prevention Alliance of gastrointestinal cancer .
Digestive Endoscopy linkage recommend imaging techniques in clinical application .
Chinese Journal of Internal Medicine .
2019 in 3 Yue .
3 , the National Alliance of gastrointestinal cancer prevention center .
Gastrointestinal Endoscopy linkage clinical application of imaging technology recommended .
Chinese Journal of Internal medicine .
2019 in 3 Yue .
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