A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy

Uedo, Noriya; Ishihara, Ryu; Iishi, Hiroyasu; Yamamoto, Sachiko; Yamada, Toshimoto; Imanaka, Kazuho; Takeuchi, Yoji; Higashino, Koji; Ishiguro, Shingo; Tatsuta, Masaharu

doi:10.1055/s-2006-944632

Cited by 327 publications

(327 citation statements)

References 10 publications

(10 reference statements)

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“…Because this study employing Congo-red chromoendoscopy confirms the significance of non-acid-secreting areas as the origin of carcinogenesis after eradication, further trials for the identification of such high risk areas with recently advanced endoscopy, such as high-resolution endoscopy with narrow band imaging (NBI) (Uedo et al 2006;Bansal et al 2008), should be a promising approach for estimating the individual cancer risk in subjects after eradication. Interestingly, a recent study has shown that, in patients with fundic atrophy, the re-emergence of the normal fundic fine structure (fundic pit) after eradication could be detected by magnifying endoscopy (Yagi et al 2005).…”

Section: Discussionsupporting

confidence: 58%

Gastric Cancers Emerging after H. pylori Eradication Arise Exclusively from Non-Acid-Secreting Areas

Iijima

Abe

Koike

et al. 2012

Tohoku J. Exp. Med.

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Although Helicobacter pylori (H. pylori) eradication has some inhibitory effects on the subsequent development of gastric cancer, there are sporadic cases of gastric cancer even after successful eradication. The pathogenesis of gastric cancer emerging after H. pylori eradication remains to be clarified. In this study, employing Congo-red chromoendoscopy, which is capable of visualizing the acid-secreting fundic mucosa, we investigated the topographic relationship of the acid secretion pattern to the occurrence site of gastric cancers emerging after eradication. Fourteen consecutive patients who suffered from new gastric cancer after eradication, defined as lesions that were discovered at least 2 years after the eradication, were prospectively enrolled. Whether the neoplasias arose from acid-secreting or nonacid-secreting areas was evaluated with Congo-red chromoendoscopy. Biopsy specimens taken from the two areas were subjected to histologic evaluation and immunohistochemistry for Ki-67 and p53. The mean period from the eradication to the subsequent occurrence of gastric cancer was 74 (44) months. There were two cancer lesions in 5 cases, and thus there was a total 19 lesions from 14 cases. Congo-red chromoendoscopy revealed that all 19 lesions arose exclusively from non-acid-secreting areas. Histological examination revealed sustained hyperproliferation and accumulation of p53 protein was frequently detectable in non-acid-secreting areas. Genetic alteration such as p53 mutation seems to be already present in the residual non-acid-secreting areas after eradication, areas that could be the origin of gastric carcinogenesis after eradication. Identification of such high-risk areas should be a promising approach for estimating the individual cancer risk after eradication.

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Section: Discussionsupporting

confidence: 58%

Gastric Cancers Emerging after H. pylori Eradication Arise Exclusively from Non-Acid-Secreting Areas

Iijima

Abe

Koike

et al. 2012

Tohoku J. Exp. Med.

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“…This technique provides better details of the mucosa and vascular patterns of minute lesions, including early gastric adenocarcinoma and GIM [9,10] . Uedo et al [11] reported on the excellent accuracy (91%) of the light blue crest (LBC) pattern detected by NBI in predicting the likelihood of GIM. Using a similar method but without magnification, a group from Missouri demonstrated that the ridge/villous pattern of the gastric mucosa detected by NBI was also useful for the diagnosis of GIM, with a sensitivity and specificity of 80% and 100%, respectively [12] .…”

Section: Introductionmentioning

confidence: 99%

Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia

Rerknimitr¹

2011

WJG

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AIM:To evaluate the efficacy of non-sequential narrow band imaging (NBI) for a better recognition of gastric intestinal metaplasia (GIM). METHODS:Previously diagnosed GIM patients underwent targeted biopsy from areas with and without GIM, as indicated by NBI, twice at an interval of 1 year. The authors compared the endoscopic criteria such as light blue crest (LBC), villous pattern (VP), and large long crest (LLC) with standard histology. The results from two surveillance endoscopies were compared with histology results for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of positive test (LR+). The number of early gastric cancer cases detected was also reported.RESULTS: NBI targeted biopsy was performed in 38 and 26 patients during the first and second surveillance endoscopies, respectively. There were 2 early gastric cancers detected in the first endoscopy. No cancer was detected from the second study. Surgical and endoscopic resections were successfully performed in each patient. Sensitivity, specificity, PPV, NPV, and LR+ of all 3 endoscopic criteria during the first/second surveillances were 78.8%/91.3%, 82.5%/89.1%, 72.8%/77.8%, 86.8%/96.1, and 4.51/8.4, respectively. LBC provided the highest LR+ over VP and LLC. CONCLUSION:Non-sequential NBI is useful for GIM targeted biopsy. LBC provides the most sensitive reading. However, the optimal duration between two surveillances requires further study.

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“…Bansal et al [13] indicated the microsurface structure of ridge/villous pattern in magnifying NBI images for IM had sensitivity of 80% and specificity of 100%, respectively. We found that a fine light bluish line of light on the epithelial surface or gyri, light blue crest, as a specific finding of IM (sensitivity 89% and specificity 93%) [14]. These types of new endoscopic imaging should enable endoscopists to diagnose certain patients with open-type atrophic gastritis as those with metaplastic gastritis (Fig.…”

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confidence: 76%

Do We Need Multiple Biopsies for Assessing Gastric Cancer Risk?

Uedo

2011

Dig Dis Sci

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A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy

Abstract: In narrow-band imaging with magnifying endoscopy, observation of a light blue crest on the epithelial surface in the gastric mucosa is a highly accurate sign of the presence of histological intestinal metaplasia.

Cited by 327 publications

References 10 publications

Gastric Cancers Emerging after H. pylori Eradication Arise Exclusively from Non-Acid-Secreting Areas

Gastric Cancers Emerging after H. pylori Eradication Arise Exclusively from Non-Acid-Secreting Areas

Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia

Do We Need Multiple Biopsies for Assessing Gastric Cancer Risk?

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