Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2021; 13(9): 426-436
Published online Sep 16, 2021. doi: 10.4253/wjge.v13.i9.426
Enlarged folds on endoscopic gastritis as a predictor for submucosal invasion of gastric cancers
Osamu Toyoshima, Shuntaro Yoshida, Toshihiro Nishizawa, Akira Toyoshima, Kosuke Sakitani, Tatsuya Matsuno, Tomoharu Yamada, Takashi Matsuo, Hayato Nakagawa, Kazuhiko Koike
Osamu Toyoshima, Shuntaro Yoshida, Toshihiro Nishizawa, Kosuke Sakitani, Tatsuya Matsuno, Tomoharu Yamada, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Setagaya-ku 157-0066, Tokyo, Japan
Toshihiro Nishizawa, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Chiba, Japan
Akira Toyoshima, Department of Colorectal Surgery, Japanese Red Cross Medical Center, Shibuya-ku 150-8935, Tokyo, Japan
Kosuke Sakitani, Department of Gastroenterology, Sakitani Endoscopy Clinic, Narashino 275-0026, Chiba, Japan
Tatsuya Matsuno, Tomoharu Yamada, Hayato Nakagawa, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku 113-8655, Tokyo, Japan
Takashi Matsuo, Department of Internal Medicine, Sakura Internal Medicine Clinic, Setagaya-ku 157-0071, Tokyo, Japan
Author contributions: Toyoshima O designed the study, recruited patients, analyzed the data, and wrote the manuscript; Nishizawa T designed the study, recruited patients, edited, and revised the manuscript; Yoshida S recruited patients and revised the manuscript; Toyoshima A, Matsuno T, Yamada T, Matsuo T, Nakagawa H, and Koike K revised the manuscript; Sakitani K reviewed endoscopic images and revised the manuscript.
Institutional review board statement: This retrospective study was approved by Certificated Review Board, Hattori Clinic on September 4, 2020 (approval No. S2009-U04).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
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: Toshihiro Nishizawa, MD, PhD, Professor, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Narita 286-8520, Chiba, Japan. nisizawa@kf7.so-net.ne.jp
Received: May 29, 2021
Peer-review started: May 29, 2021
First decision: June 11, 2021
Revised: June 12, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: September 16, 2021
Processing time: 103 Days and 16.1 Hours
ARTICLE HIGHLIGHTS
Research background

The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins.

Research motivation

In the future, artificial intelligence may be used to diagnose the depth of invasion based not only on the tumor itself but also on background gastritis.

Research objectives

We investigated predicting submucosal invasion based on endoscopic background gastritis.

Research methods

Patients with gastric cancer detected on esophagogastroduodenoscopy were enrolled. We analyzed the effects of patient and tumor characteristics including the Kyoto classification.

Research results

Endoscopic enlarged folds of gastritis (odds ratio 3.39, P = 0.001) was independently associated with submucosal invasion. Among cancer patients with enlarged folds, severely enlarged folds (width ≥ 10 mm) were more related to submucosal invasion than mildly enlarged folds (width 5-9 mm, P < 0.001).

Research conclusions

Enlarged folds of gastritis were associated with submucosal invasion.

Research perspectives

Endoscopic observation of background gastritis as well as the lesion itself may help diagnose the depth of cancer invasion.