Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2021; 13(10): 518-528
Published online Oct 16, 2021. doi: 10.4253/wjge.v13.i10.518
Association between mucosal surface pattern under near focus technology and Helicobacter pylori infection
Felipe Fiuza, Fauze Maluf-Filho, Edson Ide, Carlos Kiyoshi Furuya Jr, Sonia Nadia Fylyk, Jennifer Nakamura Ruas, Luciana Stabach, Gabriela Albuquerque Araujo, Sergio Eiji Matuguma, Ricardo Sato Uemura, Christiano Makoto Sakai, Kendi Yamazaki, Sergio Shiguetoshi Ueda, Paulo Sakai, Bruno Costa Martins
Felipe Fiuza, Fauze Maluf-Filho, Edson Ide, Carlos Kiyoshi Furuya Jr, Sonia Nadia Fylyk, Jennifer Nakamura Ruas, Luciana Stabach, Gabriela Albuquerque Araujo, Sergio Eiji Matuguma, Ricardo Sato Uemura, Christiano Makoto Sakai, Kendi Yamazaki, Sergio Shiguetoshi Ueda, Paulo Sakai, Bruno Costa Martins, Department of Endoscopy, Hospital Alemão Oswaldo Cruz, São Paulo 01323-020, Brazil
Author contributions: Martins BC and Fiuza F contributed study concept and design; all authors contributed equally acquisition of data; Martins BC and Fiuza F contributed analysis and interpretation of data; Martins BC, Fiuza F, Ide E and Maluf-Filho F contributed drafting manuscript; all authors participated in critical review and approved the final draft submitted.
Institutional review board statement: The study was reviewed and approved by the ethical committee of Hospital Alemão Oswaldo Cruz, São Paulo, Brazil (number of approval 3.577.527).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Felipe Fiuza, MD, Department of Endoscopy, Hospital Alemão Oswaldo Cruz, Treze de Maio, 1815, São Paulo 01323-020, Brazil. felipesorfiuza@gmail.com
Received: May 14, 2021
Peer-review started: May 14, 2021
First decision: July 27, 2021
Revised: August 21, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 16, 2021
ARTICLE HIGHLIGHTS
Research background

In recent years, many advances in endoscopic imaging have surged, allowing for better characterization of gastric mucosal patterns. In 2001, Yao and Oishi described the characteristics of normal gastric mucosa with image magnification (ME). In the following year, Yagi et al described the differences between the magnified view of normal gastric mucosa from the pattern seen in patients with Helicobacter pylori (H. pylori)-associated gastritis. Although there are many studies correlating the findings of ME and H. pylori status, only a few validated these findings with high definition (HD) endoscopes without ME. Moreover, most of these studies were conducted in Asian countries, in centers with high expertise with magnifying images.

Research motivation

While magnification endoscopy is well incorporated in Asian countries, in Western countries most upper endoscopes devices are not equipped with this feature.

Research objectives

The aim of this study is to access the association between mucosal surface pattern under near focus HD (NF-HD) technology and H. pylori infection status in a western population.

Research methods

This was a cross-sectional study including all patients referred to routine upper endoscopy. Endoscopic exams were performed using standard HD (S-HD) followed by NF-HD examination. Presence of erythema , erosion, atrophy, and nodularity were recorded during S-HD, and surface mucosal pattern was classified using NF-HD in the gastric body, based on the classification proposed by Anagnostopoulos et al. Biopsies were taken for rapid urease test and histology.

Research results

One hundred and eighty-seven patients were included in the study, of those, 47 (25.1%) were H. pylori +. In the examination with S-HD, erythema had the best sensitivity for H. pylori detection (80.9%). On the other hand, the absence of erythema was strongly associated with H. pylori- (negative predictive value = 92%). With NF-HD, the loss of the regular arrangement of collecting venules (RAC) presented 87.2% sensitivity for H. pylori detection and 94.3% negative predictive value, indicating that loss of RAC was suboptimal to confirm H. pylori infection, but when RAC was seen, H. pylori infection was unlikely.

Research conclusions

Presence of RAC at the NF-HD exam and the absence of erythema in the gastric body at S-HD were predictive of H. pylori negative status. The loss of RAC had a poor association with the presence of H. pylori.

Research perspectives

Our study supports the concept of first screening patients for the presence of RAC and deferring biopsy in patients positive for RAC.