Clinical applicability of gastroscopy with narrow-band imaging for the diagnosis of Helicobacter pylori gastritis, precancerous gastric lesion, and neoplasia

Abstract

Premalignant gastric lesions such as atrophic gastritis and intestinal metaplasia frequently occur in subjects with long-term Helicobacter pylori ( H . pylori ) infection. The regular arrangement of collecting venules (RAC) is seen in the normal gastric corpus, whereas mucosal swelling and redness without RAC are observed in H . pylori -infected mucosa. Despite successful H . pylori eradication, the presence of atrophic gastritis and/or gastric intestinal metaplasia (GIM) is a risk factor for gastric cancer. With the development of advanced imaging technologies, recent studies have reported the usefulness of narrow-band imaging (NBI) for endoscopic diagnosis of atrophic gastritis and GIM. Using NBI endoscopy with magnification (M-NBI), atrophic gastritis is presented as irregular coiled microvessels and loss of gastric pits. Typical M-NBI endoscopic findings of GIM are a light blue crest and a white opaque substance. Based on the microvascular patterns, fine network, core vascular, and unclear patterns are useful for predicting gastric dysplasia in polypoid lesions. For diagnosis of early gastric cancer (EGC), a systematic classification using M-NBI endoscopy has been proposed on the basis of the presence of a demarcation line and an irregular microvascular/microsurface pattern. Furthermore, M-NBI endoscopy has been found to be more accurate for determining the horizontal margin of EGC compared to conventional endoscopy. In this review, we present up-to-date results on the clinical usefulness of gastroscopy with NBI for the diagnosis of H . pylori gastritis, precancerous gastric lesion, and neoplasia.

Diagnostic approach to Helicobacter pylori-related gastric oncogenesis

“…Beyond WLI and BLI, image-enhanced endoscopy (IEE), such as narrow-band imaging (NBI) or linked color imaging (LCI), with or without magnification, have also been introduced. Recent data have suggested increased diagnostic accuracy in the detection of gastrointestinal tumors with the application of these modalities during endoscopic examination [ 26 , 27 ]: NBI endoscopy has been introduced to improve the diagnosis of H. pylori -induced gastritis, preneoplastic lesions and early gastric cancer [ 28 ]; and LCI can be used to identify gastric intestinal metaplasia and, moreover, exhibits superiority to WLI for identifying H. pylori status and gastric tumors [ 22 , 24 , 29 ]. It is important to note, however, that IEE requires substantial training and a prolonged procedure time, while there are no uniform features of H. pylori infection in IEE [ 27 ].…”

Standard vs magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions

“…Before the procedure, a soft black hood was attached to the endoscope tip to fix the distance between the endoscope tip and mucosal surface to about 2 mm. When white-light endoscopic image was magnified 80-fold ( ), we pressed the NBI button on the handle for the enhanced visualization of mucosal structures and microvessels[ 14 ]. NBI was set in enhancement mode A7 and color mode 2.…”

Scoring model for discriminating gastric cancer risk in patients with negative serum pepsinogen and anti‐Helicobacter pylori antibody results

“…The degree of gastric atrophy was graded using the endoscopic atrophic border 12 . Atrophic gastritis and intestinal metaplasia were histologically assessed in targeted biopsy specimens by narrowband imaging endoscopy 13 . One biopsy specimen was obtained from the mucosa of the corpus and another from the mucosa of the antrum from sites corresponding to narrowband imaging endoscopic findings of gastric atrophy and intestinal metaplasia.…”