Endoscopic and histological features of gastric cancers after successful Helicobacter pylori eradication therapy

Abstract

Background Gastric cancer after successful Helicobacter pylori eradication therapy is often difficult to diagnose by endoscopy because of its indistinct borderline or lack of obviously cancerous characteristics. Furthermore, it has become evident that non-neoplastic epithelium covers cancerous areas in gastric cancer after eradication. Here, we investigated these endoscopic features and their relationship to histological findings. Methods We studied 24 and 47 gastric cancers in patients who had (eradication group) and had not (control group) undergone H. pylori eradication, respectively. A gastritislike appearance revealed by conventional endoscopy was defined as a mucosal pattern with no marked difference from the surrounding non-cancerous area and that revealed by narrow-band imaging (NBI)-magnifying endoscopy (ME) as the mucosal pattern observed in H. pylori-associated atrophic gastritis. We investigated a gastritis-like appearance revealed by conventional endoscopy (A), a gastritis-like appearance at the margin (B) and within (C) the cancerous area revealed by NBI-ME, and the histological characteristics of the overlying non-neoplastic epithelium. We also evaluated the relationship between endoscopic and histological findings in the eradication group. Results Endoscopy showed that features A, B and C were significantly more frequent in the eradication group (P = 0.031, P \ 0.001, P \ 0.001, respectively). Nonneoplastic epithelium covered more than 10 % of the cancerous area more frequently in the eradication group. In the eradication group, more than 90 % of cancers showing a gastritis-like appearance had non-neoplastic epithelium extending over 10 % of the cancerous area. Conclusion Gastric cancer after successful H. pylori eradication tends to have gastritis-like features due to nonneoplastic epithelium covering the cancerous tissue.

A Comparative Study of White Light Endoscopy, Chromoendoscopy and Magnifying Endoscopy with Narrow Band Imaging in the Diagnosis of Early Gastric Cancer after Helicobacter pylori Eradication

“…Early gastric cancer after H. pylori eradication is reported as flattened and indistinct forms, which make endoscopic diagnosis difficult [7,9,10]. The normal epithelium and/or surface differentiation covering the tumor tissue has also been reported as the typical histopathological findings of gastric cancer after H. pylori eradication [8][9][10].…”

“…All EGC lesions were histologically diagnosed as differentiated adenocarcinoma. Distinct histologic changes of gastric cancer after H. pylori eradication are characterized as either regenerating non-tumorous epithelium covering over the tumorous tissue and/or surface differentiation of tumors [8][9][10], which may influence the endoscopic or histological diagnosis using the endoscopic biopsy. We investigated these histopathological characteristics in the EGC lesions.…”

“…Location, morphology, color and depth and unexpected SM2 case were using Chi statistics. such as regenerating non-tumorous epithelium covering over the tumorous tissue and/or surface differentiation of tumors [9,10], which may confuse the endoscopic diagnosis. We investigated the association between indistinct cases of EGC lesions from the eradication group and the presence of regenerating non-tumorous epithelium and/or surface differentiation of tumors.…”

“…However, gastric cancer is discovered in patients even after successful H. pylori eradication [5]. Moreover, H. pylori eradication influences the clinicopathological features of gastric tumors, including macro-and microscopic appearances [6][7][8][9][10]. Gastric cancer found after H. pylori eradication appears with indistinct forms, such as tiny and flattened lesions [6][7][8].…”

“…Gastric cancer found after H. pylori eradication appears with indistinct forms, such as tiny and flattened lesions [6][7][8]. Histopathological findings of gastric cancer after H. pylori eradication are characterized as either regenerating non-tumorous epithelium covering over the tumorous tissue and/or surface differentiation of tumors [8][9][10], which may confuse endoscopic as well as histologic diagnosis [7,9,10]. This evidence suggests that EGC after H. pylori eradication might need alternative diagnostic strategy for the precise endoscopic diagnosis.…”