Improved Visibility of Early Gastric Cancer after Successful Helicobacter pylori Eradication with Image-Enhanced Endoscopy: A Multi-Institutional Study Using Video Clips.

Shinya Matsumura,Takeshi Yasuda,Nobuaki Yagi,Yoshito Itoh,Osamu Dohi,Kazuhiko Uchiyama,Yukiko Morinaga,Takeshi Ishikawa,Akihito Harusato,Ken Inoue,Tomohisa Takagi,Yuka Azuma,Hiroaki Kitae,Yuji Naito,Takuma Yoshida,Naohisa Yoshida,Hideyuki Konishi,Tsugitaka Ishida,Kazuhiro Kamada,Ryohei Hirose,Mitsuo Kishimoto,Takehiko Doi ,Naotaka Yamada

doi:10.3390/jcm10163649

Abstract

The visibility and diagnostic accuracy of early gastric cancer (EGC) after Helicobacter pylori (HP) eradication have been reported to improve using image-enhanced endoscopy (IEE) compared with white light imaging (WLI). The present study clarified the appropriate IEE for the detection and diagnosis of EGC in clinical settings. This prospective and cross-sectional study evaluated the visibility of EGC and endoscopic findings of gastric mucosa after successful HP eradication (n = 31) using videos with WLI and IEE. Three endoscopists evaluated high-definition videos in a randomized order. The mean visibility scores (MVSs) on linked color imaging (LCI) for atrophic border, intestinal metaplasia, map-like redness, and EGC were the highest among each modality (3.87 ± 0.34, 3.82 ± 0.49, 3.87 ± 0.50, and 3.35 ± 0.92, respectively). The MVSs with blue laser imaging (BLI) were highest for magnifying view of the demarcation line (DL), microsurface pattern (MSP), and microvascular pattern (MVP) for EGC (3.77 ± 0.49, 3.94 ± 0.25, and 3.92 ± 0.34, respectively). LCI had the highest visibility among findings of gastric mucosa and EGC after HP eradication, and BLI had the highest visibility of MVP, MSP, and DL in magnifying observation. These results suggest that LCI observation in the entire stomach and further magnifying BLI are the best methods for detecting and diagnosing EGCs after HP eradication, respectively.

Highlights

Eradication therapy against Helicobacter pylori (HP) infection, which is defined as an obvious carcinogen [1], has been recommended for the prevention of gastric cancer (GC) [2]
This is the first study to evaluate the visibility of early gastric cancer (EGC) and the Kyoto classification of gastritis after HP eradication using video clips with white light imaging (WLI), blue laser imaging (BLI)/BLI-bright, and linked color imaging (LCI)
A comparative study was previously reported concerning the evaluation of EGC using still WLI, BLI, or LCI images [11,12]

Summary

Introduction

Eradication therapy against Helicobacter pylori (HP) infection, which is defined as an obvious carcinogen [1], has been recommended for the prevention of gastric cancer (GC) [2]. The visibility and diagnostic accuracy of EGC have been reported to be improved using image-enhanced endoscopy (IEE) modalities with laser light sources, including blue laser imaging (BLI) [7,8,9], and linked color imaging (LCI) [10,11,12,13], compared with WLI. BLI and LCI show enhanced endoscopic findings of HP-related gastritis, including diffuse redness, intestinal metaplasia, atrophic border, and map-like redness, compared with WLI [14,15,16,17,18,19]. There is a clinical question regarding which IEE should be applied during observation of the stomach, as which is more suitable for evaluating the visibility of EGC and endoscopic findings after HP eradication during screening endoscopy remains unclear.

Methods

Results

Conclusion