Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2021; 27(18): 2238-2250
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2238
Standard vs magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions
Jun-Hyung Cho, Seong Ran Jeon, So-Young Jin, Suyeon Park
Jun-Hyung Cho, Seong Ran Jeon, Digestive Disease Center, Soonchunhyang University Hospital, Seoul 04401, South Korea
So-Young Jin, Department of Pathology, Soonchunhyang University Hospital, Seoul 04401, South Korea
Suyeon Park, Department of Medical Biostatistics, Soonchunhyang University Hospital, Seoul 04401, South Korea
Author contributions: Cho JH was involved in the study design, performing the study, data collection and analyses, writing and revising the manuscript; Jeon SR and Jin SY were involved in the study design and revising the manuscript; Park S was involved in statistical analyses; all of the authors approved the final version of the manuscript.
Supported by the Soonchunhyang University Research Fund, No. 20200023.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Soonchunhyang University Hospital (No. SCHUH 2016-05-001).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interest.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
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: Jun-Hyung Cho, MD, PhD, Associate Professor, Digestive Disease Center, Soonchunhyang University Hospital, No. 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, South Korea. chojhmd@naver.com
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: March 29, 2021
Revised: March 31, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: May 14, 2021
ARTICLE HIGHLIGHTS
Research background

In Correa’s model of gastric carcinogenesis, Helicobacter pylori (H. pylori) infection, gastric atrophy and intestinal metaplasia (IM) are linked to gastric cancer development. The low level of serum pepsinogens (PG) was known to be highly associated with extensive atrophic gastritis.

Research motivation

High-resolution and magnifying narrow-band imaging (M-NBI) facilitate the detailed examination of gastrointestinal mucosa. M-NBI endoscopy can be used to diagnose H. pylori infection and classify gastritis by histological severity. Moreover, recent improvements in the resolution (> 1 million pixels) of gastrointestinal endoscopy have enhanced image quality, facilitating characterization of the gastric mucosal pattern. Close observation of the gastric corpus mucosa by standard endoscopy without magnification enables prediction of H. pylori gastritis and precancerous lesions.

Research objectives

To date, there was no comparative data regarding the usefulness of standard and M-NBI endoscopy for H. pylori infection and gastric precancerous conditions. We compared the diagnostic performance of standard and M-NBI endoscopy for H. pylori gastritis and precancerous conditions.

Research methods

In total, 254 patients who underwent gastroscopy were prospectively enrolled. Standard endoscopy findings of the gastric mucosal surface were classified into mosaic-like appearance (type A), diffuse homogenous redness (type B), and irregular redness with groove (type C). Gastric mucosal patterns visualized by M-NBI endoscopy were classified as regular round pits with polygonal sulci (type Z-1), more dilated and linear pits without sulci (type Z-2), and loss of gastric pits with coiled vessels (type Z-3). We evaluated the utility of the two endoscopic classifications for the diagnosis of H. pylori gastritis, gastric atrophy, IM, and a serum PG I/II ratio of ≤ 3.

Research results

The diagnostic accuracy of standard and M-NBI endoscopy for H. pylori gastritis was 93.3% and 96.1%, respectively. Regarding gastric precancerous conditions, the diagnostic accuracy of standard and M-NBI endoscopy was 72.0% vs 72.6% for moderate to severe atrophy, and 61.7% vs 61.1% for IM in the corpus, respectively. Compared to type A and Z1, types B+C and Z-2+Z-3 were significantly associated with moderate to severe atrophy [odds ratio (OR) = 5.56, P = 0.001; OR = 8.67, P = 0.007] and a serum PG I/II ratio of ≤ 3 (OR = 4.48, P = 0.004; OR = 5.69, P = 0.029).

Research conclusions

Close observation of the gastric corpus mucosa by standard and M-NBI endoscopy enables diagnosis of H. pylori infection and gastric precancerous conditions. Furthermore, our results suggest an association of endoscopic mucosal patterns with moderate to severe atrophy and a serum PG I/II ratio of ≤ 3.

Research perspectives

By gastric mucosal observation in detail, optical diagnosis of H. pylori–related gastritis may be achieved in real time. In the future, a multicenter trial is required to confirm the reliability of our results.