Advertisement

Linked color imaging identifies important risk factors associated with gastric cancer after successful eradication of Helicobacter pylori

      Background and Aims

      Limited studies have evaluated the risk factors of gastric cancer (GC) after eradication of Helicobacter pylori (H pylori) using endoscopic findings. We aimed to investigate GC detection-related endoscopic findings after eradication of H pylori using linked color imaging (LCI), a novel image-enhanced endoscopy.

      Methods

      This single-center, cross-sectional study evaluated background mucosa-associated endoscopic findings described in the Kyoto classification of gastritis in patients with newly detected GC after eradication of H pylori (CA group, n = 109) and those without GC (NC group, n = 85) using white-light imaging (WLI) and LCI.

      Results

      Severe atrophy and map-like redness were significantly more frequent in the CA group than in the NC group using WLI (79.8% vs 63.5%, P = .01; 61.5% vs 37.7%, P = .001, respectively) and LCI (79.8% vs 63.5%, P = .01; 78.0% vs 45.9%, P < .0001, respectively). Regular arrangement of collecting venules (RAC) was significantly less frequent in the CA group than in the NC group using WLI (40.3% vs 64.7%, P = .0009) and LCI (37.6% vs 62.4%, P = .0006). Map-like redness was an independent positive risk factor (WLI: odds ratio [OR], 2.05; 95% confidence interval [CI], 1.09-3.87; P = .03; LCI: OR, 3.62; 95% CI, 1.88-6.97; P < .001), whereas RAC was an independent negative risk factor (WLI: OR, 0.42; 95% CI, 0.21-0.82; P = .01; LCI: OR, 0.46; 95% CI, 0.23-0.93, P = .03) for detection of GC after eradication of H pylori.

      Conclusions

      Map-like redness, which was identified more frequently using LCI than WLI, and the absence of RAC were associated with detection of GC after eradication of H pylori.

      Abbreviations:

      CI (confidence interval), GC (gastric cancer), LCI (linked color imaging), OR (odds ratio), RAC (regular arrangement of collecting venules), WLI (white-light imaging)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nagao M.
        • Tsugane S.
        Cancer in Japan: prevalence, prevention and the role of heterocyclic amines in human carcinogenesis.
        Genes Environ. 2016; 38: 16
        • Hori M.
        • Matsuda T.
        • Shibata A.
        • et al.
        Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project.
        Jpn J Clin Oncol. 2015; 45: 884-891
        • Herrero R.
        • Park J.Y.
        • Forman D.
        The fight against gastric cancer - the IARC Working Group report.
        Best Pract Res Clin Gastroenterol. 2014; 28: 1107-1114
        • Lee Y.C.
        • Chiang T.H.
        • Chou C.K.
        • et al.
        Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis.
        Gastroenterology. 2016; 150: 1113-1124.e5
        • Ford A.C.
        • Forman D.
        • Hunt R.H.
        • et al.
        Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials.
        BMJ. 2014; 348: g3174
        • Malfertheiner P.
        • Megraud F.
        • O'Morain C.A.
        • et al.
        Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report.
        Gut. 2012; 61: 646-664
        • Majima A.
        • Handa O.
        • Naito Y.
        • et al.
        Early-stage gastric cancer can be found in improved atrophic mucosa over time from successful Helicobacter pylori eradication.
        Digestion. 2017; 95: 194-200
        • Kamada T.
        • Hata J.
        • Sugiu K.
        • et al.
        Clinical features of gastric cancer discovered after successful eradication of Helicobacter pylori: results from a 9-year prospective follow-up study in Japan.
        Aliment Pharmacol Ther. 2005; 21: 1121-1126
        • Saka A.
        • Yagi K.
        • Nimura S.
        Endoscopic and histological features of gastric cancers after successful Helicobacter pylori eradication therapy.
        Gastric Cancer. 2016; 19: 524-530
        • Take S.
        • Mizuno M.
        • Ishiki K.
        • et al.
        The long-term risk of gastric cancer after the successful eradication of Helicobacter pylori.
        J Gastroenterol. 2011; 46: 318-324
        • Masuyama H.
        • Yoshitake N.
        • Sasai T.
        • et al.
        Relationship between the degree of endoscopic atrophy of the gastric mucosa and carcinogenic risk.
        Digestion. 2015; 91: 30-36
        • Uemura N.
        • Okamoto S.
        • Yamamoto S.
        • et al.
        Helicobacter pylori infection and the development of gastric cancer.
        N Engl J Med. 2001; 345: 784-789
        • Spence A.D.
        • Cardwell C.R.
        • McMenamin U.C.
        • et al.
        Adenocarcinoma risk in gastric atrophy and intestinal metaplasia: a systematic review.
        BMC Gastroenterol. 2017; 17: 157
        • Dohi O.
        • Yagi N.
        • Onozawa Y.
        • et al.
        Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection.
        Endosc Int Open. 2016; 4: E800-E805
        • Ono S.
        • Kato M.
        • Tsuda M.
        • et al.
        Lavender color in linked color imaging enables noninvasive detection of gastric intestinal metaplasia.
        Digestion. 2018; 98: 222-230
        • Yao K.
        The endoscopic diagnosis of early gastric cancer.
        Ann Gastroenterol. 2013; 26: 11-22
        • Sugano K.
        • Tack J.
        • Kuipers E.J.
        • et al.
        Kyoto global consensus report on Helicobacter pylori gastritis.
        Gut. 2015; 64: 1353-1367
        • Kimura K.
        • Takemoto T.
        An endoscopic recognition of atrophic border and its significance in chronic gastritis.
        Endoscopy. 1969; 3: 87-97
        • Tytgat G.N.
        The Sydney System: endoscopic division. Endoscopic appearances in gastritis/duodenitis.
        J Gastroenterol Hepatol. 1991; 6: 223-234
        • Yagi K.
        • Nakamura A.
        • Sekine A.
        Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection.
        J Gastroenterol Hepatol. 2002; 17: 39-45
        • Ono H.
        • Yao K.
        • Fujishiro M.
        • et al.
        Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer.
        Dig Endosc. 2016; 28: 3-15
        • Shichijo S.
        • Hirata Y.
        • Niikura R.
        • et al.
        Histologic intestinal metaplasia and endoscopic atrophy are predictors of gastric cancer development after Helicobacter pylori eradication.
        Gastrointest Endosc. 2016; 84: 618-624
        • Watanabe K.
        • Nagata N.
        • Nakashima R.
        • et al.
        Predictive findings for Helicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: validation study.
        World J Gastroenterol. 2013; 19: 4374-4379
        • Moribata K.
        • Iguchi J.K.
        • Nakachi K.
        • et al.
        Endoscopic features associated with development of metachronous gastric cancer in patients who underwent endoscopic resection followed by Helicobacter pylori eradication.
        Dig Endosc. 2016; 28: 434-442
        • Nagata N.
        • Shimbo T.
        • Akiyama J.
        • et al.
        Predictability of gastric intestinal metaplasia by mottled patchy erythema seen on endoscopy.
        Gastroenterol Res. 2011; 4: 203-209
        • Yagi K.
        • Honda H.
        • Yang J.M.
        • et al.
        Magnifying endoscopy in gastritis of the corpus.
        Endoscopy. 2005; 37: 660-666
        • Nomura S.
        • Ida K.
        • Terao S.
        • et al.
        Endoscopic diagnosis of gastric mucosal atrophy: multicenter prospective study.
        Dig Endosc. 2014; 26: 709-719
        • Kodama M.
        • Murakami K.
        • Okimoto T.
        • et al.
        Ten-year prospective follow-up of histological changes at five points on the gastric mucosa as recommended by the updated Sydney system after Helicobacter pylori eradication.
        J Gastroenterol. 2012; 47: 394-403
        • Uedo N.
        • Ishihara R.
        • Iishi H.
        • et al.
        A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy.
        Endoscopy. 2006; 38: 819-824