Accuracy of Linked Color Imaging in the Prediction of Active Helicobacter pylori Infection: A Prospective Study
Shantanu Shahane, Rajkumar P. Wadhwa, Aathira Ravindranath, Kushan Sengupta, Madhuri Wadhwa, Raghuram Naik, Rakesh J.P, Smruti SangamAbstract
This article assesses the diagnostic accuracy of linked color imaging (LCI) for detecting active Helicobacter pylori infection.
We included patients aged > 16 years undergoing esophagogastroduodenoscopy for dyspeptic symptoms in whom H. pylori infection was suspected. The diagnostic accuracy of LCI for H. pylori gastritis was assessed using histopathological examination (HPE) as the reference standard.
A pilot study was initially conducted using endoscopic images from 50 patients obtained with white light imaging (WLI) and LCI. The detection of H. pylori positivity with LCI improved when the crimson mucosal pattern was expanded to include cerise and deep blush shades. Accordingly, all three color patterns were incorporated into the diagnostic criteria for the main study.
Images from 181 patients obtained using WLI and LCI were subsequently analyzed independently by six examiners who were blinded to the HPE results. HPE was performed by a pathologist blinded to the endoscopic findings. The sensitivity, specificity, and accuracy of WLI and LCI for diagnosing H. pylori infection were calculated using HPE as the reference standard.
The study included 181 patients (69% males), with a mean age of 45.7 years (range: 16–84 years). HPE confirmed H. pylori gastritis in 114 (63%) patients. The sensitivity, specificity, and accuracy of WLI for diagnosing H. pylori infection were 70.27, 47.34, and 60.40%, respectively. With LCI, these improved to 83.22, 71.24, and 78.73%, respectively. Both experts (accuracy, 82.87%) and nonexperts (accuracy, 74.59%) demonstrated better diagnostic performance with LCI. Inclusion of cerise and deep blush shades in addition to crimson improved the sensitivity of LCI.
LCI has a better diagnostic capability for predicting active H. pylori infection than WLI. Incorporating cerise and deep blush shades in addition to crimson into the LCI diagnostic criteria improves its sensitivity.