Comparison Between Linked Color Imaging and Blue Laser Imaging for Improving the Visibility of Flat Colorectal Polyps: A Multicenter Pilot Study



Linked color imaging (LCI) and blue laser imaging-bright (BLI-b) improve the visibility of gastrointestinal lesions. In this multicenter study, we compared the effects of LCI and BLI-b on the visibility of flat polyps with visibility scores and color difference (CD) values, including fast-withdrawal and large-monitor observation.


We recorded 120 videos of 40 consecutive flat polyps (2–20 mm), adenoma, and sessile serrated adenoma and polyp (SSA/P), using white light imaging (WLI), BLI-b, and LCI from July 2017 to December 2017. All videos were evaluated by eight endoscopists according to a published polyp visibility score of 4 (excellent) to 1 (poor). Additionally, 1.5 ×faster and 1.7 ×sized videos were evaluated. Moreover, we calculated the CD values for each polyp in three modes.


The mean LCI scores (3.1 ± 0.9) were significantly higher than the WLI scores (2.5 ± 1.0, p < 0.001) but not significantly higher than the BLI-b scores (3.0 ± 1.0). The scores of faster videos on LCI (3.0 ± 1.1) were significantly higher than WLI (2.0 ± 1.0, p < 0.001) and BLI-b (2.8 ± 1.1, p = 0.03). The scores of larger-sized videos on LCI were not significantly higher than those of WLI or BLI-b. The CD value of LCI (18.0 ± 7.7) was higher than that of WLI (11.7 ± 7.0, p < 0.001), but was not significantly higher than that of BLI-b (16.6 ± 9.6). The CD value of LCI was significantly higher than that of BLI-b for adenoma, but the CD value of BLI-b was significantly higher than that of LCI for SSA/P.


The superiority of LCI to BLI-b was proven for the visibility of adenoma and fast observation.

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We thank Dr. Kewin Tien Ho Siah, Dr. Rafiz Abdul Rani, and all members of the Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, for helping with this study.

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Correspondence to Naohisa Yoshida.

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Conflict of interest

This study was performed by a research fund from Fujifilm (J162001222). Yoshito Itoh is affiliation with a donation-funded department from FUJIFILM Medical Co. Ltd. Naohisa Yoshida received a research grant from Fujifilm Co. The other authors have no conflicts of interest to declare.

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Three movies about white light imaging, linked color imaging, and blue laser imaging-bright for a non-polypoid lesion 18 mm, adenoma on the transverse colon (Figure 3a–3c) (MP4 21788 kb)

Three normal-speed movies and three 1.5 times faster movies about white light imaging, linked color imaging, and blue laser imaging for a polypoid lesion 5 mm, adenoma on the sigmoid colon (MP4 39774 kb)

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Yoshida, N., Hisabe, T., Ikematsu, H. et al. Comparison Between Linked Color Imaging and Blue Laser Imaging for Improving the Visibility of Flat Colorectal Polyps: A Multicenter Pilot Study. Dig Dis Sci 65, 2054–2062 (2020).

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  • Colonoscopy
  • Colonic polyps
  • Linked color imaging
  • Blue laser imaging