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
Processing time: 152 Days and 17 Hours
Abstract
BACKGROUND

Many studies evaluated magnification endoscopy (ME) to correlate changes on the gastric mucosal surface with Helicobacter pylori (H. pylori) infection. However, few studies validated these concepts with high-definition endoscopy without ME.

AIM

To access the association between mucosal surface pattern under near focus technology and H. pylori infection status in a western population.

METHODS

Cross-sectional study including all patients referred to routine upper endoscopy. Endoscopic exams were performed using standard high definition (S-HD) followed by near focus (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. Biopsies were taken for rapid urease test and histology.

RESULTS

One hundred and eighty-seven patients were analyzed from August to November 2019. Of those, 47 (25.1%) were H. pylori+, and 42 (22.5%) had a previous H. pylori treatment. In the examination with S-HD, erythema had the best sensitivity for H. pylori detection (80.9%). Exudate (99.3%), nodularity (97.1%), and atrophy (95.7%) demonstrated better specificity values, but with low sensitivity (6.4%-19.1%). On the other hand, the absence of erythema was strongly associated with H. pylori- (negative predictive value = 92%). With NF-HD, 56.2% of patients presented type 1 pattern (regular arrangement of collecting venules, RAC), and only 5.7% of RAC+ patients were H. pylori+. The loss of RAC presented 87.2% sensitivity for H. pylori detection, 70.7% specificity, 50% positive predictive value, 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.

CONCLUSION

The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of H. pylori negative status. On the other hand, the loss of RAC had a suboptimal correlation with the presence of H. pylori.

Keywords: Diagnosis; Endoscopy; Gastric infection; Gastritis; Helicobacter pylori; Sensitivity and specificity

Core Tip: Imaging advances in endoscopy significantly improved our diagnostic capability. While magnification endoscopy is well incorporated in Asian countries, in Western countries most upper endoscopes devices are not equipped with this feature. In this study, we evaluated the near focus technology to access mucosal surface pattern and correlate with Helicobacter pylori infection. We believe this article will be of great interest to endoscopist in the Western, as there is still a room for better understanding gastric mucosal surface pattern and near focus technology.