Published online Jan 16, 2020. doi: 10.4253/wjge.v12.i1.23
Peer-review started: June 29, 2019
First decision: August 2, 2019
Revised: August 13, 2019
Accepted: November 18, 2019
Article in press: November 18, 2019
Published online: January 16, 2020
Accurate detection of gastric infection by Helicobacter pylori (H. pylori) and premalignant lesions are important for effective provision of treatment, preventing the development of gastric neoplasia. Optical enhancement systems with optical magnification improved the identification of mucosal superficial and vascular patterns in patients with dyspepsia.
To evaluate an optical enhancement system with high-definition magnification, for diagnosis of normal gastric mucosa, H. pylori-associated gastritis, and gastric atrophy.
A cross-sectional, nonrandomized study from November 2015 to April 2016 performed in a single-tertiary academic center from Ecuador. Seventy-two consecutive patients with functional dyspepsia according to the Rome III criteria, were tested for H. pylori using a stool antigen test and were assigned to an Hp+ group or an Hp− control group. Esophagogastroduodenoscopy with high-definition optical magnification and digital chromoendoscopy was performed, and patients were classified into 4 groups, in accordance to the microvascular-architecture pattern of the mucosa. Interobserver and intraobserver agreement among operators were calculated.
Of the 72 participants, 35 were Hp+ and 37 were Hp−. Among 10 patients with normal mucosal histology in biopsy samples, 90% had a Type I pattern of microvascular architecture by endoscopy. Among participants with type IIa and type IIb patterns, significantly more were Hp+ than Hp− (32 vs 8), and most (31 out of 40) had histological diagnoses of chronic active gastritis. Two of the three participants with a histological diagnosis of atrophy had a type III microvascular pattern. The type I pattern predicted normal mucosa, type IIa–IIb predicted H. pylori infection, and type III predicted atrophy with sensitivities of 90.0%, 91.4%, and 66.7%, respectively. The intraobserver and interobserver agreements had kappa values of 0.91 and 0.89, respectively.
High-definition optical magnification with digital chromoendoscopy is useful for diagnosis of normal gastric mucosa and H. pylori-associated gastritis with high accuracy, but further studies are needed to determine whether endoscopic diagnosis of gastric atrophy is feasible.
Core tip: The accurate and reliable detection of Helicobacter pylori-associated gastritis and gastric atrophy is imperative for appropriate therapy, preventing the development of gastric neoplasia. Digital chromoendoscopy with optical magnification improved the identification of mucosal superficial and vascular patterns in the gastric mucosa of dyspeptic patients. We described a high sensitivity and accuracy for predicting normal gastric mucosa and Helicobacter pylori-associated gastritis, with a high interobserver agreement. The accurate detection of gastric infection by Helicobacter pylori and the presence of premalignant lesion at an early stage are important for the effective provision of treatment.