Efficacy of the Kyoto Classification of Gastritis in Identifying Patients at High Risk for Gastric Cancer

Abstract

Objective The Kyoto gastritis classification categorizes the endoscopic characteristics of Helicobacter pylori (H. pylori) infection-associated gastritis and identifies patterns associated with a high risk of gastric cancer. We investigated its efficacy, comparing scores in patients with H. pylori-associated gastritis and with gastric cancer. Methods A total of 1,200 patients with H. pylori-positive gastritis alone (n=932), early-stage H. pyloripositive gastric cancer (n=189), and successfully treated H. pylori-negative cancer (n=79) were endoscopically graded according to the Kyoto gastritis classification for atrophy, intestinal metaplasia, fold hypertrophy, nodularity, and diffuse redness. Results The prevalence of O-II/O-III-type atrophy according to the Kimura-Takemoto classification in earlystage H. pylori-positive gastric cancer and successfully treated H. pylori-negative cancer groups was 45.1%, which was significantly higher than in subjects with gastritis alone (12.7%, p<0.001). Kyoto gastritis scores of atrophy and intestinal metaplasia in the H. pylori-positive cancer group were significantly higher than in subjects with gastritis alone (all p<0.001). No significant differences were noted in the rates of gastric fold hypertrophy or diffuse redness between the two groups. In a multivariate analysis, the risks for H. pyloripositive gastric cancer increased with intestinal metaplasia (odds ratio: 4.453, 95% confidence interval: 3.332-5.950, <0.001) and male sex (1.737, 1.102-2.739, p=0.017). Conclusion Making an appropriate diagnosis and detecting patients at high risk is crucial for achieving total eradication of gastric cancer. The scores of intestinal metaplasia and atrophy of the scoring system in the Kyoto gastritis classification may thus be useful for detecting these patients.

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

“…Sugimoto et al . revealed that the presence of diffuse redness in patients with primary early gastric cancer (EGC) was significantly more frequent than in those with secondary EGC . Therefore, diffuse redness was a risk factor in patients with primary intestinal‐type EGC.…”

“…The combination diagnosis using the endoscopic features in the Kyoto classification of gastritis demonstrated a high diagnostic accuracy of H. pylori infection status by endoscopists . The total score of the grading system according to this classification was useful to evaluate the risk of gastric cancer for active H. pylori gastritis . However, the total score of this grading system after H. pylori eradication therapy may not reflect the accurate risk of gastric cancer because of the disappearance of diffuse redness, nodularity, and enlarged folds.…”

“…33 The total score of the grading system according to this classification was useful to evaluate the risk of gastric cancer for active H. pylori gastritis. 28,34 However, the total score of this grading system after H. pylori eradication therapy may not reflect the accurate risk of gastric cancer because of the disappearance of diffuse redness, nodularity, and enlarged folds. Furthermore, map-like redness and the absence of RAC were identified as independent risks of gastric cancer after H. pylori eradication.…”

Evaluating the Accuracy of the Endoscopic ABC Classification System in Diagnosing Helicobacter pylori-Infected Gastritis

“…When diffuse redness is seen, since this finding's accuracy of diagnosing current H. pylori is high, it can lead to a practical eradication treatment as same as the Endo ABC. However, unlike the Endo ABC, gastric cancer risk cannot be predicted by only endoscopic features [5,6]. The Endo ABC is superior to endoscopic features to predict current and future risk of gastric cancer.…”

“…This classification is for to diagnose H. pylori-infected gastritis and to evaluate gastric cancer risk using endoscopic examination [4]. Study of the scoring system for evaluating gastric cancer risk is currently in progress [5,6]. In 2011, we published the original Endoscopic ABC (Endo ABC) classification based on an electronic endoscopy system with white light and narrow band imaging (NBI) without magnification.…”