Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2238
Peer-review started: January 27, 2021
First decision: March 29, 2021
Revised: March 31, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: May 14, 2021
Advances in endoscopic imaging enable the identification of patients at high risk of gastric cancer. However, there are no comparative data on the utility of standard and magnifying narrow-band imaging (M-NBI) endoscopy for diagnosing Helicobacter pylori (H. pylori) infection, gastric atrophy, and intestinal metaplasia.
To compare the diagnostic performance of standard and M-NBI endoscopy for H. pylori gastritis and precancerous conditions.
In 254 patients, standard endoscopy findings were classified into mosaic-like appearance (type A), diffuse homogenous redness (type B), and irregular redness with groove (type C). Gastric mucosal patterns visualized by M-NBI were classified as regular round pits with polygonal sulci (type Z-1), more dilated and linear pits without sulci (type Z-2), and loss of gastric pits with coiled vessels (type Z-3).
The diagnostic accuracy of standard and M-NBI endoscopy for H. pylori gastritis was 93.3% and 96.1%, respectively. Regarding gastric precancerous conditions, the accuracy of standard and M-NBI endoscopy was 72.0% vs 72.6% for moderate to severe atrophy, and 61.7% vs. 61.1% for intestinal metaplasia in the corpus, respectively. Compared to type A and Z-1, types B+C and Z-2+Z-3 were significantly associated with moderate to severe atrophy [odds ratio (OR) = 5.56 and 8.67] and serum pepsinogen I/II ratio of ≤ 3 (OR = 4.48 and 5.69).
Close observation of the gastric mucosa by standard and M-NBI endoscopy is useful for the diagnosis of H. pylori gastritis and precancerous conditions.
Core Tip: In Correa’s model of gastric carcinogenesis, Helicobacter pylori infection, gastric atrophy and intestinal metaplasia are linked to gastric cancer development. The low level of serum pepsinogens was known to be highly associated with extensive atrophic gastritis. High-resolution and magnifying narrow-band imaging (M-NBI) facilitate the detailed examination of gastrointestinal mucosa. However, there was no comparative data regarding the usefulness of standard and M-NBI endoscopy for H. pylori infection and gastric precancerous conditions. We found the significant relationship between endoscopic mucosal patterns and degree of gastric precancerous conditions (moderate to severe gastric atrophy and serum pepsinogen I/II ratio of ≤ 3). These results seem to be valuable for identifying a group at risk of gastric cancer using high quality endoscopy.