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

Abstract

Background & Aim: Early-stage gastric cancer (EGC) found after H. pylori eradication often has non-tumorous epithelium on the tumorous tissue and/or surface differentiation of tumors, which may confuse endoscopic and histologic diagnosis. We investigated the diagnostic reliability of EGC using conventional white light endoscopy (WLE), chromoendoscopy (CE) using indigo carmine, and magnifying endoscopy with narrow band imaging (ME-NBI) in patients with EGC with or without history of prior H. pylori eradication therapy.Methods: Diagnostic reliability of EGC by using the WLE, CE and ME-NBI was investigated in 71 EGC lesions diagnosed after successful H. pylori eradication (eradication group) and 115 EGC lesions with current H. pylori infection (control group).Results: Diagnostic reliability of EGC was lower in the eradication group than in the control group using all three modalities. In particular, the diagnostic accuracy of CE in the eradication group was especially lower compared to that of the control group (WLE: 74.6% vs. 86.1%, P=0.05; CE: 64.8% vs. 91.3%, P<0.0001; ME-NBI: 88.7% vs. 98.2%, P=0.01). The ME-NBI scored better in comparison with WLE and CE in the eradication group (both P<0.05). The indistinct EGC lesions in the eradicated group by using CE were associated with the presence of histological changes such as non-tumorous epithelium on the tumor and/or surface differentiation of tumors (P=0.005).Conclusions: It should be noted that the diagnostic reliability of EGC after H. pylori eradication becomes lower especially using CE. Indistinguishable cases using CE are associated with histological findings such as non-tumorous epithelium on the tumor and/or surface differentiation of tumors.Abbreviations: CE: chromoendoscopy; EGD: esophagogastroduodenoscopy; EGC: Early-stage gastric cancer; ESD: endoscopic submucosal dissection; H. pylori: Helicobacter pylori; ME-NBI: magnifying endoscopy with narrow band imaging; WLE: white light endoscopy.

Real-time diagnostic yield of white light endoscopy, chromoendoscopy and magnifying endoscopy with narrow band imaging in the undiagnosed gastric lesions after Helicobacter pylori eradication

“…Our result indicate that combining ME-NBI with WLE can predict pathological findings of gastric lesions in such clinical conditions with higher sensitivity, specificity and high confidence, which can reduce the number of endoscopic biopsy and can shorten the examination time. We showed that frequency of diagnosed case, as well as diagnostic yield of EGC, were not improved when combining CE with WLE compared to WLE alone, which was in line with our previous retrospective study [14]. Since the diagnosis of EGC using the conventional WLE and the CE is based on endoscopic findings of irregularly shaped depression or unevenness elevation, which are often accompanied with a color change (reddish or whitish).…”

“…The cohort consisted of 71 EGCs from 61 patients after H. pylori eradication (eradication group) and 115 EGCs with current H. pylori infection (control group). Diagnostic yield of EGC by using ME-NBI was 88.7% (63/71) in the eradication group, which was significantly lower than that of control group (98.2%: 113/115, P=0.01) [14]. This result seemed to be similar to those reported in others study, reporting that approximately 10 % of EGCs after H. pylori eradication were difficult to diagnose using ME-NBI [15].…”

“…Initially, we conducted a consensus meeting to learn ME-NBI features of EGC after H. pylori eradication associated with diagnostic difficulty. For this consensus meeting, we consulted an EGC cohort in our retrospective study [14]. performed with the GIF-H260Z or the GIF-H290Z (Olympus Corporation, Tokyo, Japan).…”

“…Since the EGC lesions in the eradication group often appear as a red color depressed lesion [6,7,14], it would be important to detect such color change by using the WLE to diagnose EGC after H. pylori eradication. On the other hand, it is possible that histological changes such as normal epithelium and/or surface differentiation covering the tumor tissue would make the depression or elevation unclear in the eradication cases.…”

“…Previous studies have demonstrated that magnifying endoscopy with narrow band imaging (ME-NBI), combined with conventional white light endoscopy (WLE) can improve the diagnostic yield of EGC [13]. However, recent retrospective studies reported that about 10 % of EGCs after H. pylori eradication were difficult to demarcate from surrounding mucosa even by using ME-NBI [14,15]. Moreover, the diagnostic strategy of combining WLE, chromoendoscopy (CE), and ME-NBI for distinguishing EGC from benign gastric lesions has not been established in patients after H.…”