Enhanced magnifying endoscopy for differential diagnosis of superficial gastric lesions identified with white-light endoscopy

Background & Aim: Early-stage gastric cancer (EGC) found after H. pylori eradication often has non-tumorous epithelium on the tumorous tissue and/or surface differentiation of tumors, which may confuse endoscopic and histologic diagnosis. We investigated the diagnostic reliability of EGC using conventional white light endoscopy (WLE), chromoendoscopy (CE) using indigo carmine, and magnifying endoscopy with narrow band imaging (ME-NBI) in patients with EGC with or without history of prior H. pylori eradication therapy.Methods: Diagnostic reliability of EGC by using the WLE, CE and ME-NBI was investigated in 71 EGC lesions diagnosed after successful H. pylori eradication (eradication group) and 115 EGC lesions with current H. pylori infection (control group).Results: Diagnostic reliability of EGC was lower in the eradication group than in the control group using all three modalities. In particular, the diagnostic accuracy of CE in the eradication group was especially lower compared to that of the control group (WLE: 74.6% vs. 86.1%, P=0.05; CE: 64.8% vs. 91.3%, P<0.0001; ME-NBI: 88.7% vs. 98.2%, P=0.01). The ME-NBI scored better in comparison with WLE and CE in the eradication group (both P<0.05). The indistinct EGC lesions in the eradicated group by using CE were associated with the presence of histological changes such as non-tumorous epithelium on the tumor and/or surface differentiation of tumors (P=0.005).Conclusions: It should be noted that the diagnostic reliability of EGC after H. pylori eradication becomes lower especially using CE. Indistinguishable cases using CE are associated with histological findings such as non-tumorous epithelium on the tumor and/or surface differentiation of tumors.Abbreviations: CE: chromoendoscopy; EGD: esophagogastroduodenoscopy; EGC: Early-stage gastric cancer; ESD: endoscopic submucosal dissection; H. pylori: Helicobacter pylori; ME-NBI: magnifying endoscopy with narrow band imaging; WLE: white light endoscopy.

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Real-time diagnostic yield of white light endoscopy, chromoendoscopy and magnifying endoscopy with narrow band imaging in the undiagnosed gastric lesions after Helicobacter pylori eradication

10.21203/rs.2.11211/v1 ◽

2019 ◽

Author(s):

Tomomitsu Tahara ◽

Noriyuki Horiguchi ◽

Tsuyoshi Terada ◽

Dai Yoshida ◽

Masaaki Okubo ◽

...

Keyword(s):

Helicobacter Pylori ◽

Real Time ◽

Narrow Band ◽

Narrow Band Imaging ◽

Diagnostic Yield ◽

Consensus Meeting ◽

Magnifying Endoscopy ◽

Gastric Lesions ◽

White Light Endoscopy ◽

H Pylori

Abstract Background: Early-stage gastric cancer (EGC) after Helicobacter pylori (H. pylori) often confuse endoscopic diagnosis. We prospectively evaluated the real-time diagnostic yield of combining white light endoscopy (WLE), chromoendoscopy (CE), and magnifying endoscopy with narrow band imaging (ME-NBI) for undiagnosed gastric lesions after H. pylori eradication. Methods: Using a retrospective data set, we conducted a consensus meeting to learn ME-NBI features of EGC after H. pylori eradication associated with diagnostic difficulty. Then, we prospectively evaluated the real-time diagnostic yield of WL, followed by CE, and ME-NBI in the diagnosis of 166 newly identified gastric lesions from 219 patients after H. pylori eradication. Results: A consensus meeting characterized ME-NBI feature of EGC with diagnostic difficulty, as having irregular vessel patterns in only tiny area of the lesion. Among 166 undiagnosed gastric lesions in the prospective study, 22 neoplastic lesions (18 adenocarcinomas and 4 adenomas) were identified. In these lesions, diagnosed case was dramatically increased when combined with ME-NBI (98%) compared to WLE alone (54%) and CE with WLE (63%) (WLE+CE+ME-NBI vs. others, all P<0.0001). In the diagnosed cases, the diagnostic accuracy was also improved when combined with ME-NBI (99.4%) compared to WLE alone (92.2%: P=0.004) and CE with WLE (95.1%: P=0.03). Conclusions: WLE combined with ME-NBI can improve the diagnostic yield of EGC in patients after H. pylori eradication. For precise diagnosis of EGC by ME-NBI, it is essential to detect irregular vessels.

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