Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2021; 27(18): 2238-2250
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2238
Standard vs magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions
Jun-Hyung Cho, Seong Ran Jeon, So-Young Jin, Suyeon Park
Jun-Hyung Cho, Seong Ran Jeon, Digestive Disease Center, Soonchunhyang University Hospital, Seoul 04401, South Korea
So-Young Jin, Department of Pathology, Soonchunhyang University Hospital, Seoul 04401, South Korea
Suyeon Park, Department of Medical Biostatistics, Soonchunhyang University Hospital, Seoul 04401, South Korea
Author contributions: Cho JH was involved in the study design, performing the study, data collection and analyses, writing and revising the manuscript; Jeon SR and Jin SY were involved in the study design and revising the manuscript; Park S was involved in statistical analyses; all of the authors approved the final version of the manuscript.
Supported by the Soonchunhyang University Research Fund, No. 20200023.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Soonchunhyang University Hospital (No. SCHUH 2016-05-001).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interest.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Hyung Cho, MD, PhD, Associate Professor, Digestive Disease Center, Soonchunhyang University Hospital, No. 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, South Korea. chojhmd@naver.com
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: March 29, 2021
Revised: March 31, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: May 14, 2021
Processing time: 103 Days and 4.2 Hours
Abstract
BACKGROUND

Advances in endoscopic imaging enable the identification of patients at high risk of gastric cancer. However, there are no comparative data on the utility of standard and magnifying narrow-band imaging (M-NBI) endoscopy for diagnosing Helicobacter pylori (H. pylori) infection, gastric atrophy, and intestinal metaplasia.

AIM

To compare the diagnostic performance of standard and M-NBI endoscopy for H. pylori gastritis and precancerous conditions.

METHODS

In 254 patients, standard endoscopy findings were classified into mosaic-like appearance (type A), diffuse homogenous redness (type B), and irregular redness with groove (type C). Gastric mucosal patterns visualized by M-NBI were classified as regular round pits with polygonal sulci (type Z-1), more dilated and linear pits without sulci (type Z-2), and loss of gastric pits with coiled vessels (type Z-3).

RESULTS

The diagnostic accuracy of standard and M-NBI endoscopy for H. pylori gastritis was 93.3% and 96.1%, respectively. Regarding gastric precancerous conditions, the accuracy of standard and M-NBI endoscopy was 72.0% vs 72.6% for moderate to severe atrophy, and 61.7% vs. 61.1% for intestinal metaplasia in the corpus, respectively. Compared to type A and Z-1, types B+C and Z-2+Z-3 were significantly associated with moderate to severe atrophy [odds ratio (OR) = 5.56 and 8.67] and serum pepsinogen I/II ratio of ≤ 3 (OR = 4.48 and 5.69).

CONCLUSION

Close observation of the gastric mucosa by standard and M-NBI endoscopy is useful for the diagnosis of H. pylori gastritis and precancerous conditions.

Keywords: Endoscopy; Magnifying narrow-band imaging; Helicobacter pylori; Gastric atrophy; Intestinal metaplasia; Pepsinogen

Core Tip: In Correa’s model of gastric carcinogenesis, Helicobacter pylori infection, gastric atrophy and intestinal metaplasia are linked to gastric cancer development. The low level of serum pepsinogens was known to be highly associated with extensive atrophic gastritis. High-resolution and magnifying narrow-band imaging (M-NBI) facilitate the detailed examination of gastrointestinal mucosa. However, there was no comparative data regarding the usefulness of standard and M-NBI endoscopy for H. pylori infection and gastric precancerous conditions. We found the significant relationship between endoscopic mucosal patterns and degree of gastric precancerous conditions (moderate to severe gastric atrophy and serum pepsinogen I/II ratio of ≤ 3). These results seem to be valuable for identifying a group at risk of gastric cancer using high quality endoscopy.