J Gastric Cancer.  2016 Sep;16(3):152-160. 10.5230/jgc.2016.16.3.152.

Usefulness of Endoscopic Imaging to Visualize Regional Alterations in Acid Secretion of Noncancerous Gastric Mucosa after Helicobacter pylori Eradication

Affiliations
  • 1Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. kaname@wa2.so-net.ne.jp
  • 2Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan.
  • 3Department of Gastroenterology, Yamagata University Graduate School of Medicine, Yamagata, Japan.

Abstract

PURPOSE
Endoscopic diagnosis of gastric cancer (GC) that emerges after eradication of Helicobacter pylori may be affected by unique morphological changes. Using comprehensive endoscopic imaging, which can reveal biological alterations in gastric mucosa after eradication, previous studies demonstrated that Congo red chromoendoscopy (CRE) might clearly show an acid non-secretory area (ANA) with malignant potential, while autofluorescence imaging (AFI) without drug injection or dyeing may achieve early detection or prediction of GC. We aimed to determine whether AFI might be an alternative to CRE for identification of high-risk areas of gastric carcinogenesis after eradication.
MATERIALS AND METHODS
We included 27 sequential patients with metachronous GC detected during endoscopic surveillance for a mean of 82.8 months after curative endoscopic resection for primary GC and eradication. After their H. pylori infection status was evaluated by clinical interviews and ¹³C-urea breath tests, the consistency in the extension of corpus atrophy (e.g., open-type or closed-type atrophy) between AFI and CRE was investigated as a primary endpoint.
RESULTS
Inconsistencies in atrophic extension between AFI and CRE were observed in 6 of 27 patients, although CRE revealed all GC cases in the ANA. Interobserver and intraobserver agreements in the evaluation of atrophic extension by AFI were significantly less than those for CRE.
CONCLUSIONS
We demonstrated that AFI findings might be less reliable for the evaluation of gastric mucosa with malignant potential after eradication than CRE findings. Therefore, special attention should be paid when we clinically evaluate AFI findings of background gastric mucosa after eradication (University Hospital Medical Information Network Center registration number: UMIN000020849).

Keyword

Stomach neoplasms; Helicobacter pylori; Endoscopy; Digestive system; Autofluorescence imaging

MeSH Terms

Atrophy
Breath Tests
Carcinogenesis
Congo Red
Diagnosis
Digestive System
Endoscopy
Gastric Mucosa*
Helicobacter pylori*
Helicobacter*
Humans
Information Services
Optical Imaging
Stomach Neoplasms
Congo Red

Figure

  • Fig. 1 Representative photographs of consistent/inconsistent extension of corpus atrophy in autofluorescence imaging (AFI) and Congo red chromoendoscopic imaging. (A, B) In consistent cases, the extension of corpus atrophy in AFI and Congo red chromoendoscopy (CRE) was judged to be open-type-II and open-type-I, respectively, according to the Kimura-Takemoto classification. (C, D) In the inconsistent cases, the extensions in AFI and CRE were open-type-I and closed-type-I, respectively.

  • Fig. 2 Representative photographs of the post-eradication gastric cancers in white-light endoscopy (A), and autofluorescence imaging (AFI) (B). (A) The color of a flat lesion located on the upper body of the stomach was similar to surrounding non-cancerous mucosa in white-light endoscopy. (B) AFI clearly visualized magenta/purple colored area in green-colored gastric mucosa.

  • Fig. 3 Representative photographs of the post-eradication gastric cancers (GCs) obscurely depicted in autofluorescence imaging (AFI). The GCs were slightly pale colored areas surrounded by mosaic-colored (A) or purple-colored (B) background mucosa in AFI. In confocal laser endomicroscopy, the lesions were located on reddish colored background mucosa (i.e., functionally atrophic corpus area).

  • Fig. 4 Consistency of the extension of corpus atrophy between autofluorescence imaging (AFI) and confocal laser endomicroscopy.


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