Barnacle-like lesions in the gastric mucosa: Clinicopathological study of a novel endoscopic finding

Abstract

Background and study aims

Map-like redness is a known gastric mucosal finding observed after Helicobacter pylori eradication. Recently, we identified gastric lesions resembling barnacles and observed that they appear more commonly in cases of post-H. pylori infection. This study aimed to investigate clinicopathological characteristics of these barnacle-like lesions.

Patients and methods

We analyzed clinical characteristics in 436 consecutive patients examined at Kawasaki Medical School General Medical Center. Histopathological examination was conducted in 43 patients, with 65 biopsies taken from barnacle-like lesions and 17 from the surrounding mucosa. The 43 patients comprised 20 patients biopsied at General Medical Center and 23 patients at Junpukai.

Results

In total, 413 patients (208 women) were included in the analysis after excluding 23 patients based on exclusion criteria. Barnacle-like lesions were identified in 66 patients (16.0%), most frequently around the gastric angle, and were significantly more common in patients with mild atrophy of the fundic mucosa. Of the 66 patients with barnacle-like lesions, 65 were considered to have a post-H. pylori infection status and one was currently infected. Histopathological examination revealed intestinal metaplasia in 54 (83.1%) of the 65 biopsies from barnacle-like lesions. By contrast, all 17 biopsies from surrounding mucosa showed normal fundic mucosa without inflammation or atrophy.

Conclusions

Barnacle-like lesions are a characteristic endoscopic finding of gastric mucosa post-infected with H. pylori and are histopathologically consistent with intestinal metaplasia.

Keywords

Endoscopy Upper GI Tract - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - Precancerous conditions & cancerous lesions (displasia and cancer) stomach

Publication History

Received: 18 November 2024

Accepted after revision: 26 June 2025

Accepted Manuscript online:
30 June 2025

Article published online:
29 July 2025

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