Clinical Significance of Reddish Depressed Lesions Observed in the Gastric Mucosa after <b><i>Helicobacter pylori</i></b> Eradication

Abstract

Background and Aim: Reddish depressed lesions (RDLs) frequently observed in patients following Helicobacter pylori eradication are indistinguishable from gastric cancer. We examined the clinical and histological feature of RDLs and its relevant endoscopic diagnosis including magnifying narrow-band imaging (M-NBI). Methods: We enrolled 301 consecutive patients with H. pylori eradication who underwent endoscopy using white light imaging (WLI). We examined the prevalence and host factors contributing to the presence of RDLs. Next, we used M-NBI in 90 patients (104 RDLs), and compared the diagnostic efficacy between M-NBI and WLI groups using propensity-score matching analysis. Results: In 301 patients after eradication, 117 (39%) showed RDLs. Male, open-type atrophy, and gastric cancer history were risk factors for RDLs. A gastric biopsy was needed in 83 (71%) during WLI observation and only 2 were diagnosed with adenocarcinoma. In M-NBI group, a biopsy was performed in 21 (20%), and 9 were diagnosed with adenocarcinoma. A biopsy was required in fewer patients, and the positive predictive value of a biopsy was statistically higher in M-NBI than in the WLI group (p < 0.01). Conclusions: RDLs are frequently observed in high-risk patients for gastric cancer after eradication. M-NBI demonstrated significantly superior diagnostic efficacy with respect to RDL.

Review: Diagnosis of Helicobacter pylori infection

“…15 Overall, when compared to histologic diagnosis, endoscopic findings using white light endoscopy did not show a good correlation, 16,17 but the new tools (NBI, LCI, and BLI) show a much better correlation thus allowing sampling of targeted biopsies instead of random biopsies from given sites in the stomach as currently recommended. 14 Reddish depressed lesions were frequently observed by magnifying NBI in high-risk patients for gastric cancer after H. pylori eradication and this technique proved to be more accurate than white light imaging.…”

“…14 Reddish depressed lesions were frequently observed by magnifying NBI in high-risk patients for gastric cancer after H. pylori eradication and this technique proved to be more accurate than white light imaging. 15 Overall, when compared to histologic diagnosis, endoscopic findings using white light endoscopy did not show a good correlation, 16,17 but the new tools (NBI, LCI, and BLI) show a much better correlation thus allowing sampling of targeted biopsies instead of random biopsies from given sites in the stomach as currently recommended.…”

Prevention of gastric cancer by Helicobacter pylori eradication: A review from Japan

“…It has also been reported that the incidence of primary EGC increases 5 years after H pylori has been eradicated . Moreover, this new form has been observed not only in MGC but also in primary EGC after H pylori eradication (Figure ) …”

“…21 Moreover, this new form has been observed not only in MGC but also in primary EGC after H pylori eradication (Figure 4). [22][23][24][25] Because this form of EGC is different from that of gastric cancer that occurs in the conventional H pylori-infected stomach, there is a possibility that this form of cancer may be misdiagnosed or diagnosed after it has progressed to a later stage. In addition, the belief among endoscopists that gastric cancer is less likely to develop after H pylori eradication may lead to a detection bias.…”

Gastric Cancer with Submucosal Invasion after Successful Helicobacter pylori Eradication: A Propensity Score-Matched Analysis of Patients with Annual Patient Endoscopic Survey

“…This result suggests that, after eradication therapy, annual endoscopic screening is the minimum es- sential for patients with a gastric cancer risk, including the presence of severe atrophy in the gastric corpus or a history of gastric cancer [25]. Furthermore, to improve endoscopic detection, we recently reported the importance of the presence of reddish depressed lesions, which may be an important finding during the endoscopic screening of patients after H. pylori eradication [26].…”