Classification of atrophic mucosal patterns on Blue LASER Imaging for endoscopic diagnosis of Helicobacter pylori-related gastritis: A retrospective, observational study

Abstract

BackgroundAtrophic gastritis can be classified according to characteristic mucosal patterns observed by Blue LASER Imaging (BLI) in a medium-range to distant view.AimsTo facilitate the endoscopic diagnosis of Helicobacter pylori (HP)-related gastritis, we investigated whether atrophic mucosal patterns correlated with HP infection based on the image interpretations of three endoscopists blinded to clinical features.MethodsThis study included 441 patients diagnosed as having atrophic gastritis by upper gastrointestinal endoscopy at Nishikawa Gastrointestinal Clinic between April 1, 2015 and March 31, 2016. The presence/absence of HP infection was not taken into consideration. Endoscopy was performed using a Fujifilm EG-L580NW scope. Atrophic mucosal patterns observed by BLI were classified into Spotty, Cracked and Mottled. Image interpretation results were that 89, 122 and 228 patients had the Spotty, Cracked and Mottled patterns, respectively, and 2 patients an undetermined pattern. Further analyses were performed on 439 patients, excluding the 2 with undetermined patterns.ResultsThe numbers of patients testing negative/positive for HP infection in the Spotty, Cracked and Mottled pattern groups were 12/77, 105/17, and 138/90, respectively. The specificity, positive predictive value and positive likelihood ratio for endoscopic diagnosis with positive HP infection based on the Spotty pattern were 95.3%, 86.5% and 8.9, respectively. In all patients with the Spotty pattern before HP eradication, the Cracked pattern was observed on subsequent post-eradication endoscopy.ConclusionsThe Spotty pattern may represent the presence of HP infection, the Cracked pattern, a post-inflammatory change as seen after HP eradication, and the Mottled pattern, intestinal metaplasia.

Can image‐enhanced endoscopy improve the diagnosis of Kyoto classification of gastritis in the clinical setting?

“…BLI‐bright is a brighter BLI to illuminate a wide lumen. BLI‐bright retrospectively identified that spotty pattern of atrophic mucosa correlated with active H. pylori infection, the cracked pattern of atrophic mucosa correlated with post‐inflammatory change after H. pylori eradication, and the mottled pattern was related with intestinal metaplasia …”

Diagnosis of Helicobacter pylori infection

“…They defined three types of mucosa: spotty, cracked, and mottled. The first appears to represent H. pylori infection, the second a postinflammatory state after H. pylori eradication, and the last intestinal metaplasia, with a good predictive value …”

“…The first appears to represent H. pylori infection, the second a postinflammatory state after H. pylori eradication, and the last intestinal metaplasia, with a good predictive value. 1 In another study, Itoh et al developed a convolutional neural network which is a machine-learning algorithm capable of recognizing specific features of gastric endoscopy images to detect H. pylori infection earlier. Both the sensitivity and specificity for detection of H. pylori infection were 86.7%.…”

“…Sabine Skrebinska 1 | Francis Mégraud 2,3 | Emilie Bessède 2,3 1 One study using magnifying endoscopy with blue laser imaging specifically looked at the clinical usefulness of the so-called VS classification (V for microvascular architecture, S for microsurface structure) for the detection of early gastric cancer. The authors concluded that this classification can be applied, but identifying the demarcation of the cancer line was difficult especially after H. pylori eradication.…”

“…The so-called soluble triggering receptor expressed on myeloid cells (sTREM-1) showed better performance and higher reliability than C-reactive protein (CRP) measurement in the gastric juice. 33 The positive and negative rates were 81.5% and 74.7% for TREM 1 Another study on a Korean adult population, including 4830 subjects, with H. pylori seropositivity in 3116 cases (64.5%), evaluated the association between serum PG level with different gastric mucosal lesions. They found a decreased PG1/2 ratio, when chronic atrophic gastritis and intestinal metaplasia were present.…”