Narrow-band imaging-modified Kyoto score predicts pathological upgrading after endoscopic submucosal dissection in gastric intraepithelial neoplasia

doi:10.3748/wjg.123704

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Dec 7, 2026; 32(45): 123704
Published online Dec 7, 2026. doi: 10.3748/wjg.123704

Narrow-band imaging-modified Kyoto score predicts pathological upgrading after endoscopic submucosal dissection in gastric intraepithelial neoplasia

Tao Chen, An-Qiang Feng, Wei-Feng Zhang, Ni-Yi Dang, Feng Ye, Guo-Xin Zhang

Tao Chen, An-Qiang Feng, Department of Gastroenterology, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, Jiangsu Province, China

Wei-Feng Zhang, Ni-Yi Dang, Feng Ye, Guo-Xin Zhang, Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China

Co-first authors: Tao Chen and An-Qiang Feng.

Author contributions: Chen T and Zhang GX designed the research study; Chen T, Feng AQ, Zhang WF, Dang NY, and Ye F performed the research and collected the data; Chen T and Feng AQ analyzed the data and they contributed equally to this manuscript as co-first authors; Chen T drafted the manuscript; Zhang GX supervised the study. All authors have read and approved the manuscript.

AI contribution statement: ChatGPT was used during manuscript revision for language refinement, formatting assistance, structural organization, and preparation of responses to reviewers. It was not used for study design, data generation, or statistical analysis. All AI-assisted content was reviewed and verified by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.

Supported by the National Natural Science Foundation of China, No. 82470593; and General Project of the Development Fund of the Affiliated Hospital of Xuzhou Medical University, No. XYFM202334.

Institutional review board statement: Ethical approval for the study protocol was granted by the Institutional Review Board of Xuzhou Central Hospital Affiliated to Southeast University (approval No. XZXY-LK-20191223-0156).

Clinical trial registration statement: This prospective observational cohort study did not involve assignment of participants to an intervention and was not registered as an interventional clinical trial.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Guo-Xin Zhang, PhD, Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. nanjingmedical@163.com

Received: May 29, 2026
Revised: July 10, 2026
Accepted: July 28, 2026
Published online: December 7, 2026
Processing time: 142 Days and 2.3 Hours

Abstract

BACKGROUND

Pathological upgrading after endoscopic submucosal dissection (ESD) remains clinically challenging in patients with gastric intraepithelial neoplasia (GIN). Existing prediction approaches mainly focus on lesion-specific features, whereas background gastric mucosal status, particularly intestinal metaplasia, is less systematically assessed. Conventional white-light endoscopy has limited accuracy and interobserver agreement in evaluating background gastric mucosal status, particularly intestinal metaplasia.

AIM

To evaluate the predictive performance of a narrow-band imaging (NBI)-modified Kyoto Gastritis Score for pathological upgrading in GIN.

METHODS

This prospective observational cohort study consecutively enrolled 225 patients with GIN undergoing ESD from 2020 to 2024. All patients underwent white-light and NBI endoscopic examinations. Conventional and NBI-modified Kyoto Gastritis Scores were assessed, with post-resection pathology as the reference standard. Receiver operating characteristic curve analysis was performed to evaluate and compare the predictive performance of the two scores. The area under the curve, sensitivity, specificity, and negative predictive value were calculated.

RESULTS

Compared with the conventional white-light Kyoto Gastritis Score, the NBI-modified score achieved a significantly higher area under the curve of 0.862 vs 0.769 (P = 0.002). The modified system improved overall diagnostic accuracy from 74.67% to 80.44%, with sensitivity increasing from 62.0% to 76.1%. At the cutoff score of ≥ 4, the positive and negative predictive values were 76.47% and 83.22%, respectively. Multivariate analysis incorporating Helicobacter pylori (H. pylori) infection status and other factors revealed that the NBI-modified Kyoto Gastritis Score was an independent risk factor for pathological progression after ESD. The predicted performance of the NBI-modified Kyoto Gastritis Score did not differ significantly between patients with current H. pylori infection and those with past/never infection.

CONCLUSION

In this single-center cohort, the NBI-modified Kyoto Gastritis Score improved prediction of pathological upgrading after endoscopic submucosal dissection and may support preoperative risk stratification, pending external validation.

Keywords: Gastric intraepithelial neoplasia; Pathological upgrading; Narrow-band imaging; Kyoto Gastritis Score; Endoscopic submucosal dissection; Intestinal metaplasia; Helicobacter pylori

Core Tip: This prospective study evaluated a narrow-band imaging-magnifying endoscopy-modified Kyoto Gastritis Score for predicting pathological upgrading after endoscopic submucosal dissection in gastric intraepithelial neoplasia. The modified score replaces white-light assessment of intestinal metaplasia with narrow-band imaging-magnifying endoscopy features, improving discrimination over the conventional score (area under the curve: 0.862 vs 0.769) and remaining independently associated with upgrading. A cutoff of ≥ 4 provided a negative predictive value of 83.22%, supporting low-risk identification and surveillance planning across Helicobacter pylori infection subgroups, although multicenter validation remains necessary.