Correlation between Gastric Mucosal Morphologic Patterns and Histopathological Severity ofHelicobacter pyloriAssociated Gastritis Using Conventional Narrow Band Imaging Gastroscopy

Abstract

Background and Aim. Identifying specific gastric mucosal morphologic patterns useful for detecting Helicobacter pylori associated gastritis and correlation with histopathological severity. Methods. The endoscopists classified the C-NBI gastroscopic findings into 5 gastric mucosal morphologic patterns as follows: type 1: regular arrangement of collecting venules, type 2: cone-shaped gastric pits, type 3: rod-shaped gastric pits with prominent sulci, type 4: ground glass-like morphology, and type 5: dark brown patches with bluish margin and irregular border. Biopsies of all of the cases were then evaluated by 5 pathologists for definitive Helicobacter pylori diagnosis. Result. Type 1 and type 2 patterns were statistically significant in predicting Helicobacter pylori negative status (58/60, P < 0.01). Type 3, type 4, and type 5 patterns were statistically significant in predicting Helicobacter pylori positive status (132/140, P < 0.01). Furthermore, the sensitivity, specificity, and positive and negative predictive values of type 3, 4, or 5 morphologies for predicting Helicobacter pylori positive were 94.28%, 96.66%, 98.50%, and 87.87%, respectively, correlated well with inflammation grading according to the Sydney classification (P < 0.01). Conclusion. Our study suggests that gastric mucosal morphologic patterns in the Helicobacter pylori infected gastric mucosa can be reliably identified using C-NBI gastroscopy with good correlation with inflammation grading.

Can image‐enhanced endoscopy improve the diagnosis of Kyoto classification of gastritis in the clinical setting?

“…Magnifying‐NBI is frequently used in Eastern countries but uncommonly in Western countries. The sensitivity and specificity for diagnosis of H. pylori infection were high according to the original classification using non‐magnifying NBI . The sensitivity of NBI for the diagnosis of intestinal metaplasia was significantly higher than that of WLI, although no significant difference was found between the accuracy of WLI and NBI for the diagnosis of H. pylori infection in a multicenter prospective study for the real‐time diagnosis of both WLI and NBI among five Western countries .…”

“…The sensitivity and specificity for diagnosis of H. pylori infection were high according to the original classification using non-magnifying NBI. 43,44 The sensitivity of NBI for the diagnosis of intestinal metaplasia was significantly higher than that of WLI, although no significant difference was found between the accuracy of WLI and NBI for the diagnosis of H. pylori infection in a multicenter prospective study for the real-time diagnosis of both WLI and NBI among five Western countries. 45 Contrarily, yellowish-white nodules visualized with NBI, which had a high specificity for the histological finding of lymphoid follicles in H. pylori-positive stomach, is suggested to be a predictive marker of nodular gastritis.…”

Diagnostic of Helicobacter pylori infection

“…Three of the five gastric mucosal morphologic patterns observed by narrow band imaging (NBI) can predict H. pylori positive status with a high accuracy in the same manner . In another study, NBI was compared to the operative link for gastritis assessment and for gastric intestinal metaplasia assessment (OLGA and OLGIM, respectively) staging systems which can separate low‐ and high‐risk groups for gastric cancer (GC).…”

Advanced endoscopic imaging in gastric neoplasia and preneoplasia

“…However, Ang et al 12 have demonstrated, in a multicentre prospective randomised study involving 579 patients, that NBI detected more focal gastric lesions as compared with high-definition WLE (40.6% vs 29%, p=0.003), as well as a greater proportion of intestinal metaplasia (17.7% vs 7.7%, p<0.001). On a similar note, Tongtawee et al 's38 study of 200 patients demonstrated that NBI also reliably identifies gastric mucosal morphological patterns associated with H. pylori infection, which correlated significantly with severity of pathological inflammation grading. A subsequent randomised study39 on 500 subjects noted site-specific biopsy guided by NBI had higher yield of diagnosing Helicobacter , as compared with standard WLE biopsy.…”