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Background and study aims  Fujifilm has developed a novel ELUXEO 7000 endoscope system that employs light-emitting diodes (LEDs) at four different wavelengths as light sources that enable blue light imaging (BLI), linked color imaging (LCI), and high-definition white-light endoscopy (HD-WLE). The aim of this study was to address the diagnostic accuracy of real-time polyp characterization using BLI, LCI and HD-WLE (ELUXEO 7000 endoscopy system). Patients methods  This is a prespecified post-hoc analysis of a prospective study in which 22 experienced endoscopists (> 2,000 colonoscopies) from eight international centers participated. Using a combination of BLI, LCI, and HD-WLE, lesions were endoscopically characterized including a high- or low-confidence statement. Per protocol, digital images were created from all three imaging modalities. Histopathology was the reference standard. Endoscopists were familiar with polyp characterization, but did not take dedicated training for purposes of this study. Results  Overall, 341 lesions were detected in 332 patients. Of the lesions, 269 histologically confirmed polyps with an optical diagnosis were included for analysis (165 adenomas, 27 sessile serrated lesions, and 77 hyperplastic polyps). Overall, polyp characterization was performed with high confidence in 82.9 %. The overall accuracy for polyp characterization was 75.1 % (95 % confidence interval [CI] 69.5-80.1 %), compared with an accuracy of 78.0 % (95 % CI 72.0-83.2 %) for high confidence assignments. The accuracy for endoscopic characterization for diminutive polyps was 74.7 % (95 %CI 68.4-80.3 %), compared with an accuracy of 78.2 % (95 % CI 71.4-84.0 %) for high-confidence assignments. Conclusions  The diagnostic accuracy of BLI, LCI, and HD-WLE by experienced endoscopist for real-time polyp characterization seems limited (NCT03344289)., Competing Interests: Competing interests Fujifilm Europe GmbH provided research equipment on loan and an unrestricted research grant for this study but had no involvement in the design, recruitment, data collection, analysis or writing of the manuscript. Dr. Repici has received loan equipment and a consultancy fee from Medtronic and Fujifilm. Dr. Bastiaansen received speaking fees from Olympus, Tillotts Pharma AG, and Ovesco Endoscopy. Dr. Dekker received equipment on loan from Olympus and Fujifilm, a research grant from Fujifilm, a consulting fee for medical advice from Tillots, Olympus, Fujifilm, GI Supply, and CPP-FAP, and a speakersʼ fee from Olympus, Roche, and GI Supply. Dr. Balaguer has endoscopic equipment on loan of Fujifilm, received an honorarium for consultancy from Sysmex, CPP-FAP speaking fees from Norgine, and an editorial fee from Elsevier. Dr. Kamiński has received speaking, teaching, and consultancy fees from Olympus (2017 to present), speaking and teaching fees and a loan of equipment from Fujifilm (2019), and speaking fees from Medtronic (2019), Alfa Sigma (2017–2019), and Norgine (2018–2019). Dr. Pellisé received a research grant from Fujifilm Spain and Casen Recordati, a loan of equipment from Fujifilm, a consultancy fee from Norgine, a speaking fee from Norgine, Olympus, Casen Recordati, and Janssen, and an editorial fee from Thieme. Dr. Bisschops has provided consultancy to and received research grants and speaking fees from Pentax (2008 to present) and Fujifilm (2015 to present); his department has received research grants and equipment from Pentax and Fujifilm (2015 to present). Dr. Bhandari has received grant funding from Norgine, Fujifilm, Olympus, Pentax, and Boston Scientific. Dr. Fockens received research support from Boston Scientific and a consulting fee from Olympus, Cook, and Ethicon Endosurgery., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)