RSS-Feed abonnieren

DOI: 10.1055/s-0042-105869
Therapeutic or spontaneous Helicobacter pylori eradication can obscure magnifying narrow-band imaging of gastric tumors
Publikationsverlauf
submitted 25. September 2015
accepted after revision 21. März 2016
Publikationsdatum:
12. Mai 2016 (online)

Background and study aims: We previously reported that narrow-band imaging with magnifying endoscopy (NBI-ME) revealed a unique “gastritis-like” appearance in approximately 40 % of early gastric cancers after Helicobacter pylori eradication. Because rates of gastric cancer are increasing in patients with non-persistent infection of H. pylori, we aimed to clarify contribution factors to obscure tumors after therapeutic or spontaneous eradication.
Patients and methods: NBI-ME findings were examined retrospectively in 194 differentiated-type adenocarcinomas from H. pylori-negative patients with prior eradication therapy (83 patients) or without prior eradication therapy (72 patients). A gastritis-like appearance under NBI-ME was defined as an orderly microsurface structure and/or loss of clear demarcation with resemblance to the adjacent, non-cancerous mucosa. The correlation of this phenomenon with the degree of atrophic gastritis, determined both histologically in the adjacent mucosa and endoscopically, was evaluated.
Results: The tumor-obscuring gastritis-like appearance was observed in 42 % and 23 % of the patients in the H. pylori eradication and non-eradication groups, respectively. The development of this appearance was affected by the histological grade of atrophy (P = 0.003) and intestinal metaplasia (P < 0.001) on univariate analysis. Multivariate analysis revealed an odds ratio of 0.25 (95 % confidence interval 0.10 – 0.61, P = 0.002) for an endoscopically severe extent of atrophy, independently of eradication therapy.
Conclusions: An endoscopically mild or moderate extent of atrophy is associated with a gastritis-like appearance under NBI-ME in currently H. pylori-negative gastric cancers. Surveillance endoscopy should be performed carefully after successful eradication or spontaneous elimination of H. pylori, particularly in patients with non-severe atrophic background mucosa.
-
References
- 1 Uemura N, Okamoto S, Yamamoto S et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001; 345: 784-789
- 2 Wu CY, Kuo KN, Wu MS et al. Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease. Gastroenterology 2009; 137: 1641-1648
- 3 Asaka M, Kato M, Takahashi S et al. Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter 2010; 15: 1-20
- 4 Take S, Mizuno M, Ishiki K et al. The effect of eradicating Helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease. Am J Gastroenterol 2005; 100: 1037-1042
- 5 Fukase K, Kato M, Kikuchi S et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008; 372: 392-397
- 6 Mabe K, Takahashi M, Oizumi H et al. Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer?. World J Gastroenterol 2009; 15: 4290-4297
- 7 Kamada T, Hata J, Sugiu K et al. Clinical features of gastric cancer discovered after successful eradication of Helicobacter pylori: results from a 9-year prospective follow-up study in Japan. Aliment Pharmacol Ther 2005; 21: 1121-1126
- 8 Ito M, Takata S, Tatsugami M et al. Clinical prevention of gastric cancer by Helicobacter pylori eradication therapy: a systematic review. J Gastroenterol 2009; 44: 365-371
- 9 Yamamoto K, Kato M, Takahashi M et al. Clinicopathological analysis of early-stage gastric cancers detected after successful eradication of Helicobacter pylori. Helicobacter 2011; 16: 210-216
- 10 Ito M, Tanaka S, Takata S et al. Morphological changes in human gastric tumours after eradication therapy of Helicobacter pylori in a short-term follow-up. Aliment Pharmacol Ther 2005; 21: 559-566
- 11 Kobayashi M, Hashimoto S, Nishikura K et al. Magnifying narrow-band imaging of surface maturation in early differentiated-type gastric cancers after Helicobacter pylori eradication. J Gastroenterol 2013; 48: 1332-1342
- 12 Matsuo T, Ito M, Takata S et al. Low prevalence of Helicobacter pylori-negative gastric cancer among Japanese. Helicobacter 2011; 16: 415-419
- 13 Ono S, Kato M, Suzuki M et al. Frequency of Helicobacter pylori-negative gastric cancer and gastric mucosal atrophy in a Japanese endoscopic submucosal dissection series including histological, endoscopic and serological atrophy. Digestion 2012; 86: 59-65
- 14 Kwak HW, Choi IJ, Cho SJ et al. Characteristics of gastric cancer according to Helicobacter pylori infection status. J Gastroenterol Hepatol 2014; 29: 1671-1677
- 15 Yao K, Anagnostopoulos GK, Ragunath K. Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy 2009; 41: 462-467
- 16 Kobayashi M, Takeuchi M, Ajioka Y et al. Mucin phenotype and narrow-band imaging with magnifying endoscopy for differentiated-type mucosal gastric cancer. J Gastroenterol 2011; 46: 1064-1070
- 17 Yagi K, Nozawa Y, Endou S et al. Diagnosis of early gastric cancer by magnifying endoscopy with NBI from viewpoint of histological imaging: mucosal patterning in terms of white zone visibility and its relationship to histology. Diagn Ther Endosc 2012; 2012: 954809
- 18 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969; 1: 87-97
- 19 Yagi K, Nakamura A, Sekine A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection. J Gastroenterol Hepatol 2002; 17: 39-45
- 20 Samloff IM, Varis K, Ihamaki T et al. Relationships among serum pepsinogen I, serum pepsinogen II and gastric mucosal histology. A study in relatives of patients with pernicious anemia. Gastroenterology 1982; 83: 204-209
- 21 Furuta T, Kaneko E, Baba S et al. Percentage changes in serum pepsinogens are useful as indices of eradication of Helicobacter pylori. Am J Gastroenterol 1997; 92: 84-88
- 22 Ohkusa T, Takashimizu I, Fujiki K et al. Changes in serum pepsinogen, gastrin, and immunoglobulin G antibody titers in Helicobacter pylori-positive gastric ulcer after eradication of infection. J Clin Gastroenterol 1997; 25: 317-322
- 23 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 3rd English edn. Gastric Cancer 2011; 14: 101-112
- 24 Lauwers GY, Carneiro F, Graham DY et al. Gastric carcinoma. In: Bosman FT, Carneiro F, Hruban RH, et al., eds. WHO classification of tumours of the digestive system. 4th. edn. Lyon, France: IARC Press; 2010: 48-58
- 25 Correa P. Chronic gastritis: a clinic-pathological classification. Am J Gastroenterol 1988; 83: 504-509
- 26 Dixon MF, Genta RM, Yardley JH et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181
- 27 Yao K, Iwashita A, Nambu M et al. Nature of white opaque substance in gastric epithelial neoplasia as visualized by magnifying endoscopy with narrow-band imaging. Dig Endosc 2012; 24: 419-425
- 28 Rugge M, Di Mario F, Cassaro M et al. Pathology of the gastric antrum and body associated with Helicobacter pylori infection in non-ulcerous patients: is the bacterium a promoter of intestinal metaplasia?. Histopathology 1993; 22: 9-15
- 29 Kodama M, Murakami K, Okimoto T et al. Histological characteristics of gastric mucosa prior to Helicobacter pylori eradication may predict gastric cancer. Scand J Gastroenterol 2013; 48: 1249-1256
- 30 Shichijo S, Hirata Y, Sakitani K et al. Distribution of intestinal metaplasia as a predictor of gastric cancer development. J Gastroenterol Hepatol 2015; 30: 1260-1264
- 31 Kanzaki H, Uedo N, Ishihara R et al. Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic fundic gastritis. Helicobacter 2012; 17: 224-231
- 32 Kodama M, Okimoto T, Ogawa R et al. Endoscopic atrophic classification before and after H. pylori eradication is closely associated with histological atrophy and intestinal metaplasia. Endosc Int Open 2015; 3: E311-E317