Abstract
Background:Barium radiographic studies have suggested the importance of evaluating areae gastricae pattern for the diagnosis of gastritis. Significance of endoscopic appearance of areae gastricae in the diagnosis of chronic atrophic fundic gastritis (CAFG) was investigated by image-enhanced endoscopy.Materials and Methods:Endoscopic images of the corpus lesser curvature were studied in 50 patients with CAFG. Extent of CAFG was evaluated with autofluorescence imaging endoscopy. The areae gastricae pattern was evaluated with 0.2% indigo carmine chromoendoscopy. Micro-mucosal structure was examined with magnifying chromoendoscopy and narrow band imaging.Results:In patients with small extent of CAFG, polygonal areae gastricae separated by a narrow intervening part of areae gastricae was observed, whereas in patients with wide extent of CAFG, the size of the areae gastricae decreased and the width of the intervening part of areae gastricae increased (p < 0.001). Most areae gastricae showed a foveola-type micro-mucosal structure (82.7%), while intervening part of areae gastricae had a groove-type structure (98.0%, p < 0.001). Groove-type mucosa had a higher grade of atrophy (p < 0.001) and intestinal metaplasia (p < 0.001) compared with foveola type.Conclusions:As extent of CAFG widened, multifocal groove-type mucosa that had high-grade atrophy and intestinal metaplasia developed among areae gastricae and increased along the intervening part of areae gastricae. Our observations facilitate our understanding of the development and progression of CAFG.
Highlights
Barium radiographic studies have suggested the importance of evaluating areae gastricae pattern for the diagnosis of gastritis
All endoscopic evaluation was performed before endoscopic submucosal dissection (ESD) procedure under sedation using a trimodal imaging endoscopy system that consisted of a light source (CLV260SL; Olympus Medical Systems, Tokyo, Japan), a processor (CV-260SL; Olympus), a video monitor, and a magnifying videoendoscope (EVIS-FQ260Z; Olympus) that was equipped with two charged coupled devices: one for high-definition white-light imaging (WLI) and narrow band imaging (NBI) modes with zoom function and another for autofluorescence imaging (AFI)
In more than 80% of patients with small extent of chronic atrophic fundic gastritis (CAFG), the region-of-interest basically consisted of areae gastricae (AG) that were divided by sulci gastricae or narrow intervening part of AG (int-AG)
Summary
We enrolled patients with early-stage noncardiac gastric cancer who presented to undergo endoscopic submucosal dissection (ESD) and gave written informed consent to participate. The following were excluded: patients who had a history of H. pylori eradication therapy or gastric surgery, those with severe organ failure or bleeding tendency, and those who were receiving anticoagulant, antiplatelet, or nonsteroidal anti-inflammatory drugs within 7 days of the study
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