The Role of Linked Color Imaging in Endoscopic Diagnosis of Helicobacter Pylori Associated Gastritis

Objective Linked color imaging (LCI), a novel image-enhanced endoscopy, can make it easy to recognize differences in mucosal color. It may be helpful for diagnosingH. pyloriassociated gastritis andH. pyloriinfection status. We investigated whether LCI could improve the diagnostic accuracy ofH. pyloriassociated gastritis. Materials and methods Upper endoscopy was performed for 100 patients using white light imaging (WLI) and LCI. During the exam, endoscopic video was recorded. It was then analyzed by four expert endoscopists. They reviewed these videos for endoscopic diagnosis of atrophic gastritis, metaplastic gastritis, nodular gastritis andH. pyloriinfection. Tissue biopsies with rapid urease test were done to confirmH. pyloriinfection status and intestinal metaplasia. Results Kappa values for the inter-observer variability among the four endoscopists were fair to moderate under WLI and fair to good under LCI. Sensitivity, specificity, positive predictive value and negative predictive value for diagnosingH. pyloriinfection using WLI were 32.4%, 93.3%, 85.2% and 53.6%, respectively, while those for LCI were 57.4%, 91.3%, 88.7% and 64.3%, respectively. Total diagnostic accuracies for diagnosingH. pyloriinfection using WLI/LCI were 70.8%/78.8%. The accuracy and sensitivity of LCI for diagnosingH. pyloriinfection were significantly higher than those of WLI (p < .001 for both). However, there were no significant differences in the accuracy, sensitivity or specificity for diagnosing metaplastic gastritis between LCI and WLI. Conclusions LCI has better diagnostic accuracy forH. pyloriinfection status than WLI.