Clinical and endoscopic characteristics of early gastric signet ring cell carcinoma based on Helicobacter pylori infection status

doi:10.4251/wjgo.v18.i3.116561

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Mar 15, 2026; 18(3): 116561
Published online Mar 15, 2026. doi: 10.4251/wjgo.v18.i3.116561

Clinical and endoscopic characteristics of early gastric signet ring cell carcinoma based on Helicobacter pylori infection status

Quan Lu, Feng Xiong, Hui-Cheng Gu, Quan-Zhou Peng, Jun Yao, De-Feng Li, Bo-Wen Huang, Li-Sheng Wang

Quan Lu, Feng Xiong, Hui-Cheng Gu, Jun Yao, De-Feng Li, Department of Gastroenterology, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China

Quan-Zhou Peng, Department of Pathology, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China

Bo-Wen Huang, Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China

Li-Sheng Wang, Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong Province, China

Co-first authors: Quan Lu and Feng Xiong.

Co-corresponding authors: Bo-Wen Huang and Li-Sheng Wang.

Author contributions: Lu Q and Xiong F contributed equally to this work; they jointly conceived the study design, conducted the data acquisition and analysis, and drafted the manuscript; Gu HC helped collect the data; Peng QZ provided the histopathologic pictures and analysis; Yao J and Li DF helped edit the manuscript. Huang BW and Wang LS contributed equally as corresponding authors; they jointly supervised the project, provided critical intellectual input, and approved the final manuscript. Wang LS is designated as the primary corresponding author responsible for communication with the journal during the submission and publication process, and for ensuring that all administrative requirements are met. All the authors have read and approved the final manuscript. Lu Q and Xiong F contributed equally to this work as co-first authors. We respectfully designate Huang BW and Wang LS as co-corresponding authors based on their equal, substantial, and complementary intellectual leadership throughout this study. Huang BW, a gastric surgeon, provided the critical oncological and surgical perspective essential for framing the study’s clinical implications and therapeutic insights. Wang LS a gastroenterologist and endoscopist, led the endoscopic methodology design, data interpretation of imaging features, and oversaw the clinical management aspects. Both authors jointly conceived the study’s core idea, supervised all stages of the project (design, analysis, and interpretation), and were integral to the final approval of the manuscript. Their synergistic guidance, bridging surgical oncology and advanced gastroenterology, was indispensable to the work’s depth and translational value. This dual correspondence accurately reflects the collaborative, interdisciplinary nature of the research. Wang LS is designated as the primary contact for editorial communication, ensuring administrative efficiency, while both share equal responsibility for the academic content.

Supported by Sanming Project of Medicine in Shenzhen, No. SZSM202211029; and Medical Scientific Research Foundation of Guangdong Province, No. B2025059.

Institutional review board statement: This study was reviewed and approved by Shenzhen People’s Hospital Institutional Review Board (Approval No. LL-KY-2025275-01).

Informed consent statement: Patients were required to give informed consent to the study. The analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: We have no financial relationships to disclose.

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.

Data sharing statement: No additional data are available.

Corresponding author: Li-Sheng Wang, MD, Chief Physician, Professor, Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), No. 1017 Dongmen North Road, Luohu District, Shenzhen 518020, Guangdong Province, China. wangls168@163.com

Received: November 19, 2025
Revised: December 22, 2025
Accepted: January 15, 2026
Published online: March 15, 2026
Processing time: 113 Days and 21 Hours

Abstract

BACKGROUND

Early gastric signet ring cell carcinoma (eGSRCC) is a distinct histological subtype of gastric cancer with unique biological behaviors. However, the impact of Helicobacter pylori (H. pylori) infection status on the clinical and endoscopic characteristics of endoscopically resectable eGSRCC remains uncertain.

AIM

To evaluate clinical and endoscopic characteristics of eGSRCC based on H. pylori status and to assess its implications for endoscopic management.

METHODS

We retrospectively analyzed consecutive patients with histologically confirmed eGSRCC at Shenzhen People’s Hospital between January 2020 and December 2024. Patients were stratified into three groups: H. pylori-positive, H. pylori-eradicated and H. pylori-uninfected. Detailed clinical and endoscopic data were compared.

RESULTS

A total of 29 patients were included, with 12 (41.4%) in the H. pylori-positive group, 7 (24.1%) in the H. pylori-eradicated group, and 10 (34.5%) in the H. pylori-uninfected group. Significant differences in endoscopic features were observed based on H. pylori status; 88.9% of the lesions were located at the lower third of gastric body and 80% presented as type 0-IIb with whitish discoloration in H. pylori-uninfected group. In contrast, more lesions in H. pylori-positive group manifested 0-IIc type with reddish roughness with or without spontaneous bleeding. Notably, all three cases of delayed post-endoscopic submucosal dissection (ESD) bleeding occurred exclusively in the H. pylori-positive group. All the cases achieved en bloc resection with no recurrence.

CONCLUSION

H. pylori infection status significantly impacts the clinical and endoscopic presentations of eGSRCC. Recognizing the differences aids early detection and H. pylori eradication prior to ESD optimizes endoscopic management.

Keywords: Early gastric cancer; Gastric signet ring cell carcinoma; Helicobacter pylori; Endoscopic submucosal dissection; Endoscopic characteristics

Core Tip: This study elucidates the different clinical and endoscopic features of early gastric signet ring cell carcinoma (eGSRCC) based on Helicobacter pylori (H. pylori) status. H. pylori-uninfected lesions were typically flat and pale in the lower gastric body, while H. pylori-positive lesions were often depressed and reddish. All delayed post-endoscopic submucosal dissection (ESD) bleeding events occurred in H. pylori-positive patients. Recognizing these patterns can aid in early detection. More importantly, H. pylori eradication prior to ESD should be considered to optimize endoscopic visualization and may reduce procedural bleeding risk, thereby refining the therapeutic approach for eGSRCC.