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Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis

  • Tomomitsu Tahara
    Correspondence
    Reprint requests: Tomomitsu Tahara, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
    Affiliations
    Current affiliations: Department of Gastroenterology (T.T., T.S., M.N., D.Y., M.O., I.H.), Fujita Health University School of Medicine, Toyoake, Japan, Department of Gastroenterology (T.A.), Kanazawa Medical University, Ishikawa, Japan
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  • Tomoyuki Shibata
    Affiliations
    Current affiliations: Department of Gastroenterology (T.T., T.S., M.N., D.Y., M.O., I.H.), Fujita Health University School of Medicine, Toyoake, Japan, Department of Gastroenterology (T.A.), Kanazawa Medical University, Ishikawa, Japan
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  • Masakatsu Nakamura
    Affiliations
    Current affiliations: Department of Gastroenterology (T.T., T.S., M.N., D.Y., M.O., I.H.), Fujita Health University School of Medicine, Toyoake, Japan, Department of Gastroenterology (T.A.), Kanazawa Medical University, Ishikawa, Japan
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  • Daisuke Yoshioka
    Affiliations
    Current affiliations: Department of Gastroenterology (T.T., T.S., M.N., D.Y., M.O., I.H.), Fujita Health University School of Medicine, Toyoake, Japan, Department of Gastroenterology (T.A.), Kanazawa Medical University, Ishikawa, Japan
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  • Masaaki Okubo
    Affiliations
    Current affiliations: Department of Gastroenterology (T.T., T.S., M.N., D.Y., M.O., I.H.), Fujita Health University School of Medicine, Toyoake, Japan, Department of Gastroenterology (T.A.), Kanazawa Medical University, Ishikawa, Japan
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  • Tomiyasu Arisawa
    Affiliations
    Current affiliations: Department of Gastroenterology (T.T., T.S., M.N., D.Y., M.O., I.H.), Fujita Health University School of Medicine, Toyoake, Japan, Department of Gastroenterology (T.A.), Kanazawa Medical University, Ishikawa, Japan
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  • Ichiro Hirata
    Affiliations
    Current affiliations: Department of Gastroenterology (T.T., T.S., M.N., D.Y., M.O., I.H.), Fujita Health University School of Medicine, Toyoake, Japan, Department of Gastroenterology (T.A.), Kanazawa Medical University, Ishikawa, Japan
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Published:April 22, 2009DOI:https://doi.org/10.1016/j.gie.2008.11.046

      Background

      Magnifying narrow-band imaging (NBI) endoscopy clearly visualizes superficial gastric mucosal patterns and capillary patterns.

      Objective

      To investigate gastric mucosal patterns by using magnifying NBI endoscopy and identify any relationship between those patterns and Helicobacter pylori–induced gastritis.

      Design

      Gastric mucosal patterns seen with magnifying NBI in uninvolved gastric corpus were divided into the following categories: normal—small, round pits with regular subepithelial capillary networks; type 1—slightly enlarged, round pits with unclear or irregular subepithelial capillary networks; type 2—obviously enlarged, oval or prolonged pits with increased density of irregular vessels; and type 3—well-demarcated oval or tubulovillous pits with clearly visible coiled or wavy vessels.

      Setting

      Department of Gastroenterology, Fujita Health University.

      Patients

      This study involved 106 participants undergoing upper endoscopy.

      Results

      H pylori infection–positive ratios of normal and types 1, 2, and 3 patterns were 7.5%, 92.9%, 94.5%, and 66.7%, respectively. Sensitivity and specificity for types 1 + 2 + 3 for detection of H pylori positivity and type 3 for detection of intestinal metaplasia were 95.2%, 82.2%, 73.3%, and 95.6%, respectively. Development of mucosal patterns from normal to types 1, 2, and 3 was correlated with all histological parameters (P < .0001), lower pepsinogen I/II ratios (P < .0001), and degree of endoscopic atrophy (P < .0001). Sensitivity and specificity of type 3 for the prediction of severe histological atrophy was also better than those of serum pepsinogen level and standard endoscopy.

      Limitations

      Only 1 endoscopist performed endoscopic procedures, and interobserver agreement could not be assessed.

      Conclusions

      Magnifying NBI endoscopy is useful for predicting H pylori infection and the histological severity of gastritis and is valuable for predicting gastric atrophy in the entire stomach.

      Abbreviations:

      CI (confidence interval), H pylori (Helicobacter pylori), NBI (narrow-band imaging), PG (pepsinogen), SD (standard deviation), SECN (subepithelial capillary network)
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