Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program

Silvia Paggi, Franco Radaelli, Carlo Senore, Roberta Maselli, Arnaldo Amato, Gianluca Andrisani, Francesco Di Matteo, Paolo Cecinato, Simone Grillo, Giuliana Sereni, Romano Sassatelli, Guido Manfredi, Saverio Alicante, Elisabetta Buscarini, Daniele Canova, Luisa Milan, Paolo Pallini, Mineo Iwatate, Emanuele Rondonotti, Alessandro RepiciCesare Hassan

Research output: Contribution to journalArticlepeer-review


Background and Aims: Linked-color imaging (LCI), a new image-enhancing technology emphasizing contrast in mucosal color, has been demonstrated to substantially reduce polyp miss rate as compared with standard white-light imaging (WLI) in tandem colonoscopy studies. Whether LCI increases adenoma detection rate (ADR) remains unclear. Methods: Consecutive subjects undergoing screening colonoscopy after fecal immunochemical test (FIT) positivity were 1:1 randomized to undergo colonoscopy with LCI or WLI, both in high-definition systems. Insertion and withdrawal phases of each colonoscopy were carried out using the same assigned light. Experienced endoscopists from 7 Italian centers participated in the study. Randomization was stratified by gender, age, and screening round. The primary outcome measure was represented by ADR. Results: Of 704 eligible subjects, 649 were included (48.9% men, mean age ± standard deviation, 60.8 ± 7.3 years) and randomized to LCI (n = 326) or WLI (n = 323) colonoscopy. The ADR was higher in the LCI group (51.8%) than in the WLI group (43.7%) (relative risk, 1.19; 95% confidence interval, 1.01-1.40). The proportions of patients with advanced adenomas and sessile serrated lesions were, respectively, 21.2% and 8.6% in the LCI arm and 18.9% and 5.9% in the WLI arm (not significant for both comparisons). At multivariate analysis, LCI was independently associated with ADR, along with male gender, increasing age, and adequate (Boston Bowel Preparation Scale score ≥6) bowel preparation. At per-polyp analysis, the mean ± standard deviation number of adenomas per colonoscopy was comparable in the LCI and WLI arms, whereas the corresponding figures for proximal adenomas was significantly higher in the LCI group (.72 ± 1.2 vs. 55 ± 1.07, P = .05) Conclusions: In FIT-positive patients undergoing screening colonoscopy, the routine use of LCI significantly increased the ADR. (Clinical trial registration number: NCT03690297.)

Original languageEnglish
Pages (from-to)723-730
Number of pages8
JournalGastrointestinal Endoscopy
Issue number3
Publication statusPublished - Sep 2020

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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