胃と腸57巻13号

2022年12月発行

今月の主題 IEEを使いこなす 主題

LCIを使いこなす—上部消化管

著者： 小野尚子¹ 松本将吾² 東野真幸² 曽根孝之² 久保茉理奈² 西村友佑² 大野正芳² 山本桂子² 坂本直哉²

所属機関： ¹北海道大学病院光学医療診療部 ²北海道大学大学院医学研究院内科学講座消化器内科学

ページ範囲：P.1666 - P.1674

要旨●LCI（linked color imaging）は白色光観察用の光に加え，青紫色の短波長を強く照射し，さらに色調拡張技術を用いて赤色領域の彩度差・色相差を拡張する画像強調技術である．白色光同様に明るさが維持されるため，非拡大ルーチン検査に使用できる．上皮性腫瘍部は表面微小血管の増生を反映し，白色光観察では淡い発赤を呈することが多い．LCIでは発赤がより増強され，食道癌は濃い桃色，胃癌は橙赤色に描出されることが多い．背景粘膜との色調差が大きくなるため，病変は検出されやすくなる一方で，LCIでは多彩な色調で観察される胃炎所見について若干の習熟が必要である．

参考文献

1）丹羽寛文，田尻久雄．内視鏡観察法に関する新たな分類の提唱．臨消内科　23：137-141, 2007

2）Kitagawa Y, Suzuki T, Nankinzan R, et al. Comparison of endoscopic visibility and miss rate for early gastric cancers after Helicobacter pylori eradication with white-light imaging versus linked color imaging. Dig Endosc　32：769-777, 2020

3）Ishida T, Dohi O, Yoshida N, et al. Enhanced visibility in evaluating gastric cancer and Helicobacter pylori-associated gastritis using linked color imaging with a light-emitting diode light source. Dig Dis Sci　67：2367-2374, 2022

4）八尾建史，上堂文也，鎌田智有，他．早期胃癌の内視鏡診断ガイドライン．Gastroenterol Endosc　61：1283-1319, 2019

5）Muto M, Minashi K, Yano T, et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging：a multicenter randomized controlled trial. J Clin Oncol　28：1566-1572, 2010

6）Ono S, Kawada K, Dohi O, et al. Linked color imaging focused on neoplasm detection in the upper gastrointestinal tract：A randomized trial. Ann Intern Med　174：18-24, 2021

7）Nakamura K, Urabe Y, Oka S, et al. Usefulness of linked color imaging in the early detection of superficial esophageal squamous cell carcinomas. Esophagus　18：118-124, 2021

8）Haruma K, Kato M, Kawada K, et al. Diagnostic ability of linked color imaging in ultraslim endoscopy to identify neoplastic lesions in the upper gastrointestinal tract. Endosc Int Open　10：E88-95, 2022

9）Saito M, Koike T, Ohara Y, et al. Linked-color imaging may help improve the visibility of superficial Barrett's esophageal adenocarcinoma by increasing the color difference. Intern Med　60：3351-3358, 2021

10）加藤隆弘，八木信明，鎌田智有，他．Helicobacter pylori感染胃粘膜の内視鏡診断：多施設前向き研究．Gastroenterol Endosc　56：1813-1824, 2014

11）春間賢（監），加藤元嗣，井上和彦，村上和成，他（編）．胃炎の京都分類，改訂第2版．日本メディカルセンター，2018

12）小野尚子，加藤元嗣，浅香正弘．Helicobacter pylori除菌後の経時的拡大内視鏡像の変化．消化器内科　51：252-257, 2010

13）Ono S, Dohi O, Yagi N, et al. Accuracies of endoscopic diagnosis of Helicobacter pylori-gastritis：multicenter prospective study using white light imaging and linked color imaging. Digestion　101：624-630, 2020

14）Sakae H, Kanzaki H, Satomi T, et al. Linked color imaging（LCI）emphasizes the color changes in the gastric mucosa after Helicobacter pylori eradication. Dig Dis Sci　67：2375-2384, 2022

15）Kaminishi M, Yamaguchi H, Nomura S, et al. Endoscopic classification of chronic gastritis based on the result of a pilot study by Research Society for Gastritis. Gastroenterol Endosc　45：1277-1291, 2003

16）Uedo N, Ishihara R, Iishi H, et al. A new method of diagnosing gastric intestinal metaplasia：narrow-band imaging with magnifying endoscopy. Endoscopy　38：819-824, 2006

17）Yao K, Iwashita A, Nambu M, et al. Nature of white opaque substance in gastric epithelial neoplasia as visualized by magnifying endoscopy with narrow-band imaging. Dig Endosc　24：419-425, 2012

18）An JK, Song GA, Kim GH, et al. Marginal turbid band and light blue crest, signs observed in magnifying narrow-band imaging endoscopy, are indicative of gastric intestinal metaplasia. BMC Gastroenterol　12：169, 2012

19）Song J, Zhang J, Wang J, et al. Meta-analysis：narrow band imaging for diagnosis of gastric intestinal metaplasia. PLoS One　9：e94869, 2014

20）小野尚子，加藤元嗣．Linked Color Imaging（LCI）による腸上皮化生の内視鏡診断．Gastroenterol Endosc　59：465-474, 2017

21）Ono S, Kato M, Tsuda M, et al. Lavender color in linked color imaging enables noninvasive detection of gastric intestinal metaplasia. Digestion　98：222-230, 2018

22）Shu X, Wu G, Zheng Y, et al. Diagnostic value of linked color imaging based on endoscopy for gastric intestinal metaplasia：a systematic review and meta-analysis. Ann Transl Med　9：506, 2021

23）Fukuda H, Miura Y, Hayashi Y, et al. Linked color imaging technology facilitates early detection of flat gastric cancers. Clin J Gastroenterol　8：385-389, 2015

24）Ono S, Abiko S, Kato M. Linked color imaging enhances gastric cancer in gastric intestinal metaplasia. Dig Endosc　29：230-231, 2017

25）Yasuda T, Yagi N, Omatsu T, et al. Benefits of linked color imaging for recognition of early differentiated-type gastric cancer：in comparison with indigo carmine contrast method and blue laser imaging. Surg Endosc　35：2750-2758, 2021

26）Fujiyoshi T, Miyahara R, Funasaka K, et al. Utility of linked color imaging for endoscopic diagnosis of early gastric cancer. World J Gastroenterol　25：1248-1258, 2019

27）Matsumura S, Dohi O, Yamada N, et al. Improved visibility of early gastric cancer after successful Helicobacter pylori eradication with image-enhanced endoscopy：A multi-institutional study using video clips. J Clin Med　10：3649, 2021

28）Fukuda H, Miura Y, Osawa H, et al. Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia. J Gastroenterol　54：396-406, 2019

29）Gao J, Zhang X, Meng Q, et al. Linked color imaging can improve detection rate of early gastric cancer in a high-risk population：A multi-center randomized controlled clinical trial. Dig Dis Sci　66：1212-1219, 2021

30）Okimoto K, Maruoka D, Matsumura T, et al. Linked color imaging can improve the visibility of superficial non-ampullary duodenal epithelial tumors. Sci Rep　10：20667, 2020

31）Kitae H, Dohi O, Naito Y, et al. Linked color imaging and blue laser imaging for the diagnosis of superficial non-ampullary duodenal epithelial tumors. Dig Dis　2022［Epub ahead of print］