An Endoscopic Recognition of the Atrophic Border and its Significance in Chronic Gastritis

Effect of Helicobacter pylori Eradication on Metabolic Parameters and Body Composition including Skeletal Muscle Mass: A Matched Case-Control Study

Background/Aims

Findings on the impact of Helicobacter pylori eradication on metabolic parameters are inconsistent. This study aimed to evaluate the effects of H. pylori eradication on metabolic parameters and body composition, including body fat mass and skeletal muscle mass.

Methods

We retrospectively reviewed the data of asymptomatic patients who underwent health screenings, including bioelectrical impedance analysis, before and after H. pylori eradication between 2005 and 2021. After matching individuals based on key factors, we compared lipid profiles, metabolic parameters, and body composition between 823 patients from the eradicated group and 823 patients from the non-eradicated groups.

Results

Blood pressure, erythrocyte sedimentation rate, and glycated hemoglobin values were significantly lower in the eradicated group than in the non-eradicated group. However, changes in body mass index (BMI), body fat mass, appendicular skeletal muscle mass (ASM), waist circumference, and lipid profiles were not significantly different between the two groups. In a subgroup analysis of individuals aged >45 years, blood pressure, erythrocyte sedimentation rate, and glycated hemoglobin changes were significantly lower in the eradicated group than in the non-eradicated group. BMI values were significantly higher in the eradicated group than in the non-eradicated group; however, no significant differences were observed between the two groups regarding changes in body weight, body fat mass, ASM, or waist circumference. Total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the eradicated group than in non-eradicated group.

Conclusions

H. pylori eradication significantly reduced blood pressure, glucose levels, and systemic inflammation and improved lipid profiles in patients aged >45 years. BMI, body fat mass, ASM, and waist circumference did not significantly differ between patients in the eradicated group and those in the non-eradicated group.

Endoscopic features differentiating non-Helicobacter pylori Helicobacter-induced gastric mucosa-associated lymphoid tissue lymphoma with a nodular gastritis-like appearance and H. pylori-induced conventional nodular gastritis

OBJECTIVES

Conventional nodular gastritis has been known to be caused by Helicobacter pylori infection. Several cases of gastric mucosa-associated lymphoid tissue (MALT) lymphoma with non-H. pylori Helicobacters (NHPH) exhibit endoscopic findings resembling nodular gastritis. Considering the differences in malignancy, distinguishing between these two conditions is crucial. This study aimed to identify the distinguishing endoscopic features of NHPH-induced gastric MALT lymphoma with nodular gastritis-like appearance (NHPHi-MNG) and H.-induced conventional nodular gastritis (HPi-NG).

METHODS

Between 2011 and 2022, we analyzed 17 patients with NHPHi-MNG and 50 patients with HPi-NG at Hiroshima University Hospital and evaluated nodule morphology and distribution patterns.

RESULTS

Compared with the HPi-NG group, the NHPHi-MNG group exhibited significantly larger nodules (2.5 vs. 2.0 mm, P < 0.05) with protruded morphology (protruded/superficial, elevated: 14/3 vs. 8/42, P < 0.05), most prominently in the gastric angulus. The variability in nodule size was significantly higher in the NHPHi-MNG group than in the HPi-NG group (0.85 vs. 0.37 mm, P < 0.05), reflecting nodule heterogeneity. The distance from the gastric angulus to the proximal end of the nodular lesions was significantly greater in the NHPHi-MNG group than in the HPi-NG group (4.4 vs. 1.7 cm, P < 0.05). The nodules in the HPi-NG group were smaller, superficial, elevated, and most prominent in the gastric antrum compared with those in the NHPHi-MNG group. They were predominantly distributed in the gastric antrum with a homogeneous morphology.

CONCLUSION

NHPHi-MNG and HPi-NG can be endoscopically differentiated according to nodule morphology and distribution. Recognizing these distinguishing features is essential for an accurate diagnosis.

The Role of Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) in Assessing the Extent and Degree of Gastric Intestinal Metaplasia

OBJECTIVES

We aimed to evaluate the consistency between endoscopic grading of gastric intestinal metaplasia (EGGIM) and the operative link on gastric intestinal metaplasia assessment (OLGIM) staging, as well as the value of endoscopic grading of gastric intestinal metaplasia (GIM) in early gastric cancer (EGC) risk.

METHODS

The sample size was estimated to be at least 210 patients. To evaluate GIM, EGGIM staging was used during magnifying endoscopy with narrow-band imaging, while the OLGIM staging was carried out according to the updated Sydney system. The consistency between the two scoring systems and the accuracy of EGGIM in diagnosing OLGIM III/IV cases were evaluated. EGC risk was evaluated using the Kimura-Takemoto classification, the operative link on gastritis assessment (OLGA)/OLGIM, and EGGIM.

RESULTS

Among the 210 patients, 68 (32.4%) had (previous) EGC and 142 (67.6%) had chronic atrophic gastritis (CAG). EGGIM and OLGIM staging showed good consistency (κ = 0.805, U = 12.620, p < 0.001) in diagnosing OLGIM III/IV GIM, with an area under the receiver operating characteristic curve for EGGIM of 0.95. Using a cut-off value of > 4, the sensitivity and specificity were 95.7% and 91.4%, respectively. The EGGIM score was higher in the EGC group than in the CAG group (4.93 vs. 3.92, p < 0.001).

CONCLUSIONS

EGGIM shows good diagnostic performance and consistency with OLGIM, which can simplify endoscopic surveillance by reducing the need for biopsy. The EGGIM score is associated with EGC risk, and endoscopic surveillance is recommended for patients with EGGIM score > 4.

Prevalence of gastric epithelial neoplasm of fundic-gland mucosa lineage diagnosed by medical checkup findings and time-course changes

BACKGROUND

This study was performed to investigate the prevalence of gastric epithelial neoplasm of fundic-gland mucosa lineage (GEN-FGML) and time-course changes in endoscopic findings in affected subjects who underwent an esophagogastroduodenoscopy (EGD) examination as part of an annual checkup.

METHODS

A total of 39,292 EGD examinations (25,228 men, 14,034 women; mean age: 53.6 years) were performed between April 2016 and March 2024. The prevalence of GEN-FGML was analyzed, and time-course changes noted in endoscopic findings of diagnosed tumors were investigated by comparison with previous endoscopic images.

RESULTS

During the study period, we identified 19 patients with 20 GEN-FGML diagnosed based on endoscopic and histological results, with a prevalence of 0.048%. Prevalence was not different between Helicobacter pylori-uninfected and -eradicated cases (0.050% and 0.051%, respectively). Endoscopy findings of 16 of these tumors for which time-course changes could be investigated (median observation period: 8.5 years) showed that 15 were unchanged in size in comparison with previous EGD findings, while one showed enlargement. In addition, three lesions diagnosed after H. pylori eradication were unchanged in size compared to before eradication.

CONCLUSIONS

The prevalence of GEN-FGML by screening EGD was 0.048%, with prevalence not different between H. pylori-uninfected and -eradicated subjects. Enlargement over time was not observed in almost all cases, and H. pylori infection status was considered not to influence changes in tumor size.

Prevalence and Distribution of Gastric Endoscopy Findings in Non-eosinophilic Esophagitis Eosinophilic Gastrointestinal Diseases: Influence of Atrophic Gastritis

Objective The impact of Helicobacter pylori infection on gastric endoscopic findings in non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) remains unclear. This study investigated the influence of H. pylori infection on the prevalence and distribution of gastric lesions. Methods The details of 75 patients diagnosed with non-EoE EGIDs were retrospectively reviewed. Of the 56 patients with a definitive diagnosis according to the Japanese criteria (any GI tract; ≥20 eosinophils/high-power field), 25 patients with pathologic gastric eosinophilic infiltration (EI) (gastric EI; ≥30 eosinophils/high power field) were investigated in detail. The prevalence and distribution of gastric endoscopy findings were assessed according to the gastric mucosal atrophy status, an indicator of H. pylori infection. Results Erythema (76%) was the most common finding in the gastric EI-positive group, followed by erosions (36%), ulcers (28%), ulcer scars (28%), and edema (24%). None of these lesions differed significantly in frequency between the patients with and without gastric atrophy. When erosions, ulcers, and ulcer scars were unified, they were slightly more common in the gastric bodies of patients with gastric atrophy than those without gastric atrophy; however, no preferential site was found in those without gastric atrophy. We identified six patients with active gastric ulcers, and half had large, deep ulcers with marginal swelling/irregularity. Conclusion Gastric endoscopy findings in non-EoE EGIDs with gastric EI were evenly observed in the stomach, with no specific trend in frequency or distribution depending on atrophic gastritis, an indicator of H. pylori infection. Gastric ulcers in patients with non-EoE EGIDs should be considered in the differential diagnosis of idiopathic peptic ulcers.

Precision risk stratification of primary gastric cancer after eradication of H. pylori by a DNA methylation marker: a multicentre prospective study

BACKGROUND

Precision cancer risk stratification for gastric cancer is urgently needed for the growing number of healthy people after Helicobacter pylori eradication. The epimutation burden in non-malignant tissues has been associated with cancer risk in multiple cross-sectional studies.

OBJECTIVE

To confirm the clinical usefulness of a DNA methylation marker for epimutation burden, and to identify a cut-off methylation level for a super-high-risk population.

DESIGN

Healthy people after H. pylori eradication with open-type atrophy were prospectively recruited. DNA methylation levels of a marker gene, RIMS1, were measured in biopsy specimens from gastric antrum and body. The primary endpoint was the incidence rate of gastric cancer in quartiles of the methylation levels.

RESULTS

1624 participants had at least one endoscopic follow-up with a median follow-up of 4.05 years, and a primary gastric cancer developed in 27 participants. The highest quartile of RIMS1 methylation levels had a higher incidence rate (972.8 per 100 000 person-years) than the lowest quartile (127.1). Cox regression analysis revealed a univariate HR of 7.7 (95% CI 1.8-33.7) and an age- and sex-adjusted HR of 5.7 (95% CI 1.3-25.5). As a secondary objective, a cut-off methylation level of 25.7% (95% CI 1.7-7.7) was obtained to identify a population with a super-high risk based on the number needed to screen of 1000.

CONCLUSION

A DNA methylation marker can risk-stratify healthy people after H. pylori eradication even though all of them have clinically high risk. Individuals with super-high risk will need more frequent gastric cancer screening than currently recommended.

TRIAL REGISTRATION NUMBER

UMIN-CTR000016894.

Iron deposition in gastric black spots: Clinicopathological insights and NanoSuit-correlative light and electron microscopy analysis

OBJECTIVES

Black spots (BSs) are lentiginous findings observed in the gastric body and fundus during upper gastrointestinal endoscopy and are predominantly seen in patients undergoing Helicobacter pylori eradication treatment. However, the detailed patient background and exact composition are poorly understood. This study aims to clarify the clinicopathological features of BSs, examine patient demographics, and use the NanoSuit-correlative light and electron microscopy (CLEM) method combined with scanning electron microscopy-energy dispersive X-ray spectroscopy for elemental analysis.

METHODS

Patients who underwent upper gastrointestinal endoscopy between 2017 and 2022 were included. Data on age, medications, blood tests, and H. pylori infection status were retrospectively gathered from medical records. Univariate analysis was conducted to examine BS presence, with results then used in a multivariate model to identify associated risk factors. Additionally, pathological specimens from patients with BSs were analyzed for elemental composition using the NanoSuit-CLEM method combined with scanning electronmicroscopy-energy dispersive X-ray spectroscopy.

RESULTS

An analysis of 6778 cases identified risk factors for BSs, including older age and using proton pump inhibitors, statins, corticosteroids, and antithrombotic drugs. Endoscopically, BSs correlated with higher gastric atrophy and lower active H. pylori infection. Iron deposition at BS sites was specifically identified using NanoSuit-CLEM.

CONCLUSIONS

BSs on gastrointestinal endoscopy may indicate an absence of active H. pylori inflammation. The discovery of iron deposition within BSs using the NanoSuit-CLEM method has offered new insights into the possible causative factors and advances our understanding of the etiology of BSs, bringing us closer to unraveling the underlying mechanisms of their formation.

Characteristics of Superficial Gastric Neoplasms Detected Not by White Light Imaging but by Linked Color Imaging

Background and Aims

Laser endoscopy has a linked color imaging (LCI) mode which has been reported to be superior to white light imaging (WLI) in detecting early gastric cancer (EGC). In this study, we retrospectively investigated the characteristics of superficial gastric neoplasms detected not by WLI but by LCI.

Patients and Methods

From April 2018 to May 2023, EGC or gastric adenoma identified by EGD was observed using LCI after WLI. The size, location, macroscopic type, color, skill level of the endoscopists, and treatment were examined for lesions detected by WLI (WLI group) and lesions detected not by WLI but by LCI (LCI group).

Results

Eighty-eight lesions of EGCs were differentiated adenocarcinomas, 13 undifferentiated adenocarcinomas, and 28 gastric adenomas. There were 117 lesions (90.7%) in the WLI group and 12 (9.2%) in the LCI group. The mean diameter was 22.9 mm in the WLI group and 9.3 mm in the LCI group, with the latter being significantly smaller (p = 0.003). The numbers of protruding, depressed, and flat lesions were 58, 59, and 0 in the WLI group, and 7, 4, and 1 in the LCI group, respectively, indicating that more protruding lesions were detected in the LCI group (p = 0.005). After multivariate analysis, there was a significant difference in diameter only in the LCI group compared to the WLI group (odds ratio, 0.834; 95% CI, 0.728-0.956).

Conclusions

LCI is more useful than WLI for detecting smaller superficial gastric neoplasms.

Endoscopic features of gastric neuroendocrine tumors

OBJECTIVES

The endoscopic features of gastric neuroendocrine tumors (G-NETs) remain unclarified. The present study investigated the endoscopic features of G-NETs in relation to the clinicopathological findings.

METHODS

This retrospective study analyzed consecutive patients with G-NETs who received endoscopic or surgical treatment between January 2005 and December 2023. The endoscopic and clinicopathological findings of the lesions were analyzed to provide diagnostic information.

RESULTS

Among 29 patients, the characteristic endoscopic findings of G-NETs on white-light images were reddish color (66%), dilated vessels (83%), submucosal tumor-like marginal elevation (59%), and central depression (48%). The gross appearance of G-NETs was classified into two macroscopic subtypes: reddish polypoid lesions (n = 17) and submucosal tumor-like lesions (n = 9). Magnifying narrow-band imaging endoscopy revealed an absent microsurface pattern plus an irregular microvascular pattern in all cases of reddish polypoid lesions with central depressions (100%, 9/9). The findings of a reddish polypoid lesion and an absent microsurface pattern plus an irregular microvascular pattern corresponded to the subepithelial NET component close to the non-neoplastic surface epithelium. Additionally, reddish polypoid lesions were significantly more frequent in type 1 G-NETs than in type 3 G-NETs (80% vs. 11%, p < 0.001), while submucosal tumor-like lesions were significantly more frequent in type 3 G-NETs than in type 1 G-NETs (78% vs. 10%, p < 0.001).

CONCLUSIONS

These endoscopic features should increase the index of suspicion and help clinicians to correctly diagnose G-NETs through the pathological examination of biopsy specimens.

A novel endoscopic artificial intelligence system to assist in the diagnosis of autoimmune gastritis: a multicenter study

BACKGROUND

 Autoimmune gastritis (AIG), distinct from Helicobacter pylori-associated atrophic gastritis (HpAG), is underdiagnosed due to limited awareness. This multicenter study aimed to develop a novel endoscopic artificial intelligence (AI) system for assisting in AIG diagnosis.

METHODS

 Patients diagnosed with AIG, HpAG, or nonatrophic gastritis (NAG), were retrospectively enrolled from six centers. Endoscopic images with relevant demographic and medical data were collected for development of the AI-assisted system based on a multi-site feature fusion model. The diagnostic performance of the AI model was evaluated in internal and external datasets. Endoscopists' performance with and without AI support was tested and compared using Mann-Whitney U test. Heatmap analysis was performed to interpret AI model outputs.

RESULTS

 18 828 endoscopy images from 1070 patients (294 AIG, 386 HpAG, 390 NAG) were collected. On testing datasets, AI identified AIG with 96.9 % sensitivity, 92.2 % specificity, and area under the receiver operating characteristic curve (AUROC) of 0.990 (internal), and 90.3 % sensitivity, 93.1 % specificity, and AUROC of 0.973 (external). The performance of AI (sensitivity 91.3 %) was comparable to that of experts (87.3 %) and significantly outperformed nonexperts (70.0 %; P = 0.01). With AI support, the overall performance of endoscopists was improved (sensitivity 90.3 % [95 %CI 86.0 %-93.2 %] vs. 78.7 % [95 %CI 73.6 %-83.2 %]; P = 0.008). Heatmap analysis revealed consistent focus of AI on atrophic areas.

CONCLUSIONS

 This novel AI system demonstrated expert-level performance in identifying AIG and enhanced the diagnostic ability of endoscopists. Its application could be useful in guiding biopsy sampling and improving early detection of AIG.

Prevalence of gastric cancer following colorectal endoscopic submucosal dissection for lesions more than 20 mm: A retrospective analysis

OBJECTIVES

Colorectal endoscopic submucosal dissection (ESD) for large tumors is spreading worldwide. Gastric cancer (GC) sometimes occurs after colorectal ESD. However, its status including frequency and risk factors have not been examined well. In this study, we analyzed the detailed status of GC after colorectal ESD.

METHODS

This was a single-center retrospective study. Patients receiving colorectal ESD between 2010 and 2018 were reviewed. All patients were recommended to receive esophagogastroduodenoscopy (EGD) for screening. Finally, 436 patients receiving EGD, who underwent colorectal ESD for lesions of ≥20 mm were analyzed. The primary outcome was the GC rate after colorectal ESD, including intramucosal cancer. As a control, we compared it to the GC rate in matched Japanese national cancer registry data. The secondary outcome was risk factors for developing GC.

RESULTS

The mean age was 66.9 ± 10.6 and 55.3% were males. The GC rate was 5.96% (26/436) with a median observation period of 27 months. It was significantly higher than the mean GC rate in the diagnosed age calculated with the cancer registry (0.26%, observed value/expected value ratio [95% confidence interval]: 22.20 [14.50-32.53], p < 0.01). The comparison between cases with and without GC showed that significant risk factors were male (p = 0.02) and smokers (p < 0.01) and their GC rates were 8.3% and 10.9%. Also, in the limited cases, Helicobacter pylori infection (past and present) and atrophic gastritis were significant and their GC rates were 11.1% and 11.6%.

CONCLUSION

The GC rate was high after resecting colorectal tumors of ≥20 mm, suggesting the necessity of EGD.

A risk prediction model for gastric cancer based on endoscopic atrophy classification

BACKGROUNDS

Gastric cancer (GC) is a prevalent malignancy affecting the digestive system. We aimed to develop a risk prediction model based on endoscopic atrophy classification for GC.

METHODS

We retrospectively collected the data from January 2020 to October 2021 in our hospital and randomly divided the patients into training and validation sets in an 8:2 ratio. We used multiple machine learning algorithms such as logistic regression (LR), Decision tree, Support Vector Machine, Random forest, and so on to establish the models. We employed the Least absolute shrinkage and selection operator (LASSO) to screen variables for the LR model. However, we chose all the variables to construct the models for other machine learning algorithms. All models were evaluated using the receiver operating characteristic curve (ROC), predictive histograms, and decision curve analysis (DCA).

RESULTS

A total of 1156 patients were selected for the analysis. Five variables, including age, sex, family history of GC, HP infection status, and Kimura-Takemoto Classification (KTC), were screened using LASSO analysis. The area under the curve (AUC) of all the machine learning models ranged from 0.762 to 0.974 in the training set and from 0.608 to 0.812 in the validation set. Among them, the LR model exhibited the highest AUC value (0.812, 95%CI: 0.737-0.887) in the validation set with good calibration and clinical applicability. Finally, we constructed a nomogram to demonstrate the LR model.

CONCLUSIONS

We established a nomogram based on endoscopic atrophy classification for GC, which might be valuable in predicting GC risk and assisting clinical decision-making.

Assessing gastric cancer risk using the OLGA and OLGIM systems in Republic of Moldova

Background

Gastric cancer is still an important public health problem. Efforts have been made to lower its prevalence globally. The Operative Link on Gastritis Assessment (OLGA) and operating link for gastric intestinal metaplasia (OLGIM) histological grading systems have been proposed to identify individuals with types of gastritis that have the potential to become malignant.

Aim of the study

Our study was conducted to assess the value of OLGA and OLGIM systems in the diagnosis of gastric precancerous lesions, in the Moldovan population.

Methods

In a prospective study, 142 consecutive patients with chronic atrophic gastritis (CAG) from a larger group of patients referred to upper gastrointestinal endoscopy for dyspeptic symptoms or gastric cancer screening was investigated. The sample was divided into three groups: (a) CAG without intestinal metaplasia and gastric dysplasia; (b) CAG with intestinal metaplasia; (c) CAG with gastric dysplasia according to the morphological type of the lesion. GastroPanel biomarkers were correlated with OLGA and OLGIM stages.

Results

There was a direct, moderate and statistically significant correlation between types of CAG and OLGA stages (p < 0.001), a direct, weak and statistically significant correlation between forms of chronic atrophic gastritis and OLGIM stages (p < 0.001). A statistically significant reduction in Pepsinogen I and the Pepsinogen-I/Pepsinogen-II ratio was observed alongside an increase in the stages of the OLGA and OLGIM systems.

Conclusion

OLGA and OLGIM systems are useful tools in diagnosing CAG. This is the first study assessing the use of this systems in the Moldovan population.

Nomogram Prediction for Gastric Cancer Development

INTRODUCTION

Helicobacter pylori ( Hp ) and gastric atrophy represent significant risk factors for gastric cancer (GC). Nevertheless, to date, no nomogram has been developed to predict GC based on the specific combination of risk factors present in individual cases.

METHODS

A retrospective cohort study was conducted using health screening data collected between 2003 and 2018. Subjects with positive results for anti- Hp antibody were enrolled. Individuals were classified into 4 groups: low-B (low titer without atrophy), high-B (high titer without atrophy), high-C (high titer with atrophy), and low-C (low titer with atrophy). Nomogram prediction models were developed for overall GCs as well as intestinal and diffuse cancers, with each type considered a competing event, by using both Cox proportional and subdistribution hazard models. Prediction performance was evaluated using the concordance index (c-index) and the area under the curve through 10-fold cross-validation.

RESULTS

During a median follow-up period of 5.7 years, 231 new GC cases developed among the total cohort of 28,311 subjects, including 159 intestinal type, 68 diffuse type, and 4 cases of unknown type. Multivariable analyses indicated that age, body mass index, family history, smoking, and classification into the high-C or low-C group were significant predictors of GC. The nomograms for intestinal type, diffuse type, and total GC demonstrated area under the curve values of 0.82, 0.62, and 0.75, respectively, and c-indices of 0.85, 0.54, and 0.76, respectively.

DISCUSSION

The nomograms for GC prediction would be useful in identifying high-risk individuals, particularly for intestinal type. This would facilitate the implementation of personalized eradication and intensive screening strategies to target those at higher risk for GC.

Effectiveness of Artificial Intelligence in Screening Esophagogastroduodenoscopy

BACKGROUND

This retrospective study investigated the usefulness of the EW10-EG01 artificial intelligence (AI) application for screening esophagogastroduodenoscopy (EGD).

METHODOLOGY

A total of 7,655 subjects (4,863 men, 2,792 women; mean age 54.9±10.1 years) who underwent EGD during a medical checkup were enrolled in the study. The number of diagnosed upper gastrointestinal tumors was compared between EGD examinations performed with and without the AI system.

RESULTS

EGD examinations with and without the AI system were performed on 3,841 and 3,814 subjects, respectively. Biopsy procedures were more frequently performed, and examination time was longer in EGD with AI applications than in those without. Upper gastrointestinal tumors diagnosed by EGD with and without AI were 39 (1.02%) and 24 (0.63%), respectively (P = 0.062). There was a significant difference in the detection rate of esophageal and gastric tumors between EGD with (30, 0.78%) and without (14, 0.37%) the AI system (P = 0.017). When endoscopists were divided into three groups based on their experience with the EW10-EG01 application, higher detection rates of esophageal and gastric tumors were observed in each group when using EGD with AI.

CONCLUSIONS

Usage of the EW10-EG01 AI system may be useful for screening EGD due to the increased esophageal and gastric tumor detection rate.

Improved visibility of palisade vessels within Barrett's esophagus using red dichromatic imaging: a retrospective cross-sectional study in Japan

BACKGROUND/AIMS

Visualization of palisade vessels (PVs) in Barrett's esophagus is crucial for proper assessment. This study aimed to determine whether red dichromatic imaging (RDI) improves PV visibility compared with white-light imaging (WLI) and narrow-band imaging (NBI).

METHODS

Five expert and trainee endoscopists evaluated the PV visibility in Barrett's esophagus using WLI, NBI, and RDI on 66 images from 22 patients. Visibility was rated on a 4-point scale: 4, excellent; 3, good; 2, fair; and 1, poor. The color difference between the most recognizable PV spots and surrounding areas with undetectable blood vessels was also analyzed.

RESULTS

Mean visibility scores were 2.6±0.7, 2.3±0.6, and 3.4±0.4 for WLI, NBI, and RDI, respectively. The RDI scores were significantly higher than the WLI (p<0.001) and NBI (p<0.001) scores. These differences were recognized by trainees and expert endoscopists. Color differences in PVs were 7.74±4.96 (WLI), 10.43±5.09 (NBI), and 15.1±6.54 (RDI). The difference in RDI was significantly higher than that in WLI (p<0.001) and NBI (p=0.006).

CONCLUSIONS

RDI significantly improved PV visibility compared to WLI and NBI based on objective and subjective measures.

Relationship between gastric mucosal atrophy by endoscopy and non-ampullary duodenal epithelial tumors

BACKGROUND

The pathogenesis of non-ampullary duodenal epithelial tumors (NADETs) is not fully understood. NADETs that express gastric-type mucin phenotypes (G-NADETs) are noteworthy because of their high malignancy. Gastric foveolar metaplasia, from which G-NADETs originate, protects the duodenal mucosa from gastric acidity. As gastric acid secretion is affected by endoscopic gastric mucosal atrophy (EGMA), we hypothesized that EGMA would be associated with G-NADETs.

AIM

To evaluate the association between EGMA and the occurrence of G-NADETs.

METHODS

This cross-sectional retrospective study investigated the relationship between EGMA and NADETs in 134 patients. The duodenum was divided into parts 1 (bulb), 2 (superior duodenal angle to the papilla), and 3 (anal side of the papilla to the horizontal part). The effects of gastric acidity and presence of Brunner's glands were considered. EGMA was divided into types C (no or mild atrophy) and O (severe atrophy). Mucin phenotype expressions in NADETs were divided into gastric, intestinal, gastrointestinal, and unclassifiable.

RESULTS

When NADETs were classified according to EGMA, 105 were classified as type C and 29 as type O. G-NADETs were present in 11.9% (16 cases) of all cases, and all 16 cases were of type C. Among G-NADETs, 93.8% (15 cases) were present in part 1 or 2. There was an association between G-NADETs and type C in part 1, and 50.0% (eight of 16 cases) of G-NADETs were associated with a current or previous Helicobacter pylori infection status. Additionally, all eight cases occurred in part 1.

CONCLUSION

G-NADETs were significantly associated with type C. Gastric acidity and Brunner's gland growth may be associated with G-NADETs.

Age distribution and risk factors for Barrett's esophagus by sex at health check-up settings in Japan

BACKGROUND

Given the high prevalence of esophageal adenocarcinoma and Barrett's esophagus (BE), a precancerous lesion, among males, it is important to understand the characteristics of BE by sex to develop an effective endoscopic surveillance program in Japan. The present study examined the age distribution and risk factors for BE in the Japanese health check-up cohort by sex.

METHODS

The data set at baseline of our preceding multicenter study, comprising a total of 33,478 individuals who underwent upper endoscopic screening at 17 health check-up institutes across Japan, was utilized. BE and long-segment BE (LSBE) were defined as a columnar-lined esophagus ≥ 1 cm and ≥ 3 cm, respectively. Logistic regression analyses were performed to ascertain the factors associated with BE.

RESULTS

BE was relatively common (10-20%) across all 10-year age groups in men and women. Although the prevalence of LSBE was rare (0.2%), it began to increase at younger ages in men. In the multivariable analysis of the male cohort, while body mass index (BMI) was negatively associated with BE with an adjusted odds ratio (95% confidence interval) of 0.84 (0.74-0.95), waist circumference (WC) was positively associated with 1.26 (1.13-1.41). Furthermore, this association was more pronounced in LSBE. In contrast, no such association was observed between BMI or WC and BE in women.

CONCLUSION

The nationwide Japanese multicenter study yielded insights into the age distribution of BE in the Japanese population. Furthermore, our findings indicate that a low BMI/high WC represents a significant risk factor for BE in the Japanese male population.

Rapid Development of a Hemorrhagic Hyperplastic Polyp in a Patient with Evolving Autoimmune Gastritis after Helicobacter pylori Eradication

In 2020, a 56-year-old woman with a history of Helicobacter pylori (H. pylori) eradication 9 years previously presented with a hemorrhagic hyperplastic polyp. Endoscopic and histological findings led to the diagnosis of advanced-stage autoimmune gastritis (AIG). A review of endoscopic findings from 2014 was available, and narrow-band imaging showed swelling of the gastric areas, characteristic of early-stage AIG. Together with the rapid growth of a hyperplastic polyp, these findings suggest a case of AIG that rapidly exacerbated after eradication. To our knowledge, this is the first case report of a rapidly developing hemorrhagic hyperplastic polyp associated with AIG after H. pylori eradication.

Predictors of the Development of Gastric Cancer in Post-Helicobacter pylori-Eradication Patients Followed Up for More than 10 Years: A Histological, Serological, and Endoscopic Study

BACKGROUND/OBJECTIVES

Although Helicobacter pylori (H. pylori) eradication therapy is important for preventing gastric cancer (GC), the occurrence of GC after H. pylori eradication remains a problem. In this study, the aim was to identify risk factors for GC after H. pylori eradication by comparing long-term histological, endoscopic, and serological evaluations of patients with and without GC.

METHODS

Patients who underwent H. pylori eradication therapy at Oita University Hospital between June 1997 and August 2013 and were followed for at least 3 years with long-term endoscopy, histology, and serum biochemical tests were included, and the GC (215 cases) and non-GC (11 cases) groups were compared.

RESULTS

The GC group was older than the non-GC group at the time of eradication, had lower serum pepsinogen I/II levels, had severe endoscopic atrophic changes, had higher activity at the antrum, and inflammation and intestinal metaplasia (IM) at the corpus on updated Sydney system scoring. On long-term follow-up after eradication, the GC group had a wider range of endoscopic mucosal atrophy and a lower serum pepsinogen I/II ratio at any time point.

CONCLUSIONS

Endoscopic mucosal atrophy and the serum pepsinogen I/II ratio are useful predictors of GC in patients post H. pylori eradication at any time point.

Prevalence and factors associated with web‑like mucus in the stomach after vonoprazan use

The appearance of 'web-like mucus' in the stomach is a novel phenomenon associated with vonoprazan (VPZ) usage, characterized by a descriptive mucus pattern resembling a spider web or net. The present study aimed to determine its prevalence and related factors. In this retrospective observational study, the medical records and endoscopic reports of 547 patients who underwent an esophagogastroduodenoscopy were reviewed. The overall prevalence of web-like mucus was 6% (33/547), with 97% (32/33) of these patients being VPZ users. Specifically, 19% (32/167) of VPZ users exhibited this web-like mucus pattern, which was significantly more prevalent in the VPZ group than in the control (no acid blocker intake), proton pump inhibitor, and histamine-2 receptor antagonist groups. Multivariate analysis identified that VPZ use was positively associated with web-like mucus, while open-type gastric atrophy and multiple white and flat elevated lesions were negatively associated. A retrospective analysis of endoscopic findings before initiating VPZ therapy showed that none of the 32 VPZ users with web-like mucus had exhibited the pattern previously. Furthermore, the Cochran-Armitage trend test indicated no significant association between the duration of VPZ therapy and the prevalence of web-like mucus. In conclusion, web-like mucus in the stomach is strongly associated with VPZ use but is not associated with the duration of VPZ therapy.

Characteristics of Early Gastric Cancer in a Patient with a History of Helicobacter pylori Infection and No History of Eradication Therapy

Objective The characteristics of gastric cancer in patients with atrophic mucosa and no apparent history of Helicobacter pylori eradication have not been thoroughly investigated. Therefore, this study examined the clinicopathological characteristics of gastric cancer in these patients. Methods We retrospectively examined the endoscopic and pathological characteristics of gastric cancer in patients who underwent endoscopic submucosal dissection. Patients We divided the patients into 2 groups: those with gastric atrophy and no history of eradication (group A; n=102) and those with a history of eradication (group B; n=161). In group A, patients were further divided into mild atrophy (group C) and severe atrophy (group D) groups, while group B was further divided into those who underwent eradication treatment >5 years ago (group E) and those who underwent eradication 1-5 years ago (group F). Results Group A comprised significantly older individuals (75±8.0 vs. 71±7.5 years old, p<0.001) with a higher frequency of elevated gastric cancer than group B (32.4% vs. 17.4%, p=0.006). Compared with group E, group A was older and had a greater incidence of elevated gastric cancer. The incidence of gastric cancer in the U or M region was lower in group C than in group D. Conclusion Gastric cancer in patients with gastric atrophy and no history of eradication was associated with an older age and higher frequency of elevated-type morphology than in those with a history of eradication.

Point-of-Care Diagnosis of Atrophic Gastritis by Serological Biomarker Test (GastroPanel® Quick Test) in Gastroscopy Referral Patients in India

Background: Increased demand of the serological biomarker test (GastroPanel®) in non-invasive diagnosis of gastric cancer (GC) risk conditions, i.e., atrophic gastritis (AG) and Helicobacter pylori (Hp) infection, prompted the design of GastroPanel® Quick test (GPQT) (Biohit Oyj, Helsinki, Finland) for point-of-care (POC) settings. Objective: This study validated the diagnostic accuracy (DA) of GPQT in diagnosis of AG and Hp among gastroscopy referral patients. Methods: Altogether, 266 patients were enrolled among the consecutive gastroscopy referrals at the Department of Gastroenterology, Fortis Hospital (Punjab, India). All patients underwent gastroscopy with biopsies (n = 249) classified using the Updated Sydney System (USS) and finger prick blood sampling for GPQT testing. Results: Biopsy-confirmed AG was found in 15.3% (38/249) of the patients. The overall agreement between the GPQT and the USS classification was 71.4% (95% CI 65.4-77.0%), with the weighted kappa (κw) of 0.823 (95% CI 0.773-0.862). In ROC analysis for moderate/severe AG of the corpus (AGC) endpoint, AUC = 0.990 (95% CI 0.979-1.000) and AUC = 0.971 (95% CI 0.948-0.995) for PGI and PGI/PGII, respectively. Hp IgG Ab test detected biopsy-confirmed Hp with AUC = 0.836 (95% CI 0.783-0.889). Conclusions: The GPQT favourably competes in accuracy with the ELISA test version (unified-GP) in diagnosis of AG and Hp in patients referred for diagnostic gastroscopy.

Innovative nomogram approach to enhance the prediction of Helicobacter pylori infection in children via magnetic-controlled capsule endoscopy

Early detection and intervention are crucial in managing Helicobacter pylori (HP) infections, which are associated with various gastrointestinal diseases in children. The traditional Kyoto gastritis scoring system, though effective, requires adaptation for non-invasive techniques like magnetic-controlled capsule endoscopy to enhance early diagnosis and improve patient comfort. This retrospective study involved 474 pediatric patients who underwent magnetic-controlled capsule endoscopy coupled with a 13C urea breath test at the Children's Hospital affiliated with Shanghai Jiao Tong University School of Medicine from January to December 2023. Utilizing the Kyoto gastritis scoring system, adapted for magnetic-controlled capsule endoscopy, we evaluated its effectiveness in diagnosing HP infection. To enhance diagnostic precision, a nomogram was developed that integrates these gastritis scores with demographic and clinical variables, providing a comprehensive tool for assessing the risk of HP infection. Our findings indicate that a Kyoto gastritis score of ≥ 2 has a high predictive accuracy for HP infection, with an area under the curve (AUC) of 0.755 (95% CI 0.697-0.813). The study highlighted Kyoto gastritis score and white mucous as significant predictors of infection, with odds ratios of 5.94 (95% CI 3.40-10.49) and 2.78 (95% CI 1.65-4.71), respectively. A predictive model incorporating these factors alongside demographic and clinical variables demonstrated robust diagnostic potential. The nomogram, incorporating these factors, showed robust diagnostic potential and improved the predictive accuracy.

CONCLUSIONS

The adapted Kyoto gastritis scoring system for magnetic-controlled capsule endoscopy offers a promising approach for the early detection of HP infection in children. By integrating multiple diagnostic indicators from non-invasive magnetic-controlled capsule endoscopy, this model enhances early diagnostic accuracy and can significantly reduce discomfort and risks associated with traditional endoscopic procedures.

WHAT IS KNOWN

• The 13C urea breath test is used to screen children for Helicobacter pylori infection. Gastroendoscopy for the assessment of digestive diseases in children.

WHAT IS NEW

• Magnetic-controlled capsule endoscopy for the assessment of digestive diseases in children, combined with 13C urea breath test to improve the diagnosis of Helicobacter pylori in children.

Endoscopic and clinical characteristics of autoimmune atrophic gastritis: Retrospective study

Background and study aims

Autoimmune atrophic gastritis (AIG) is a rare chronic autoimmune disease characterized by gastric mucosa inflammation and atrophy. Limited clinical data exist about AIG, especially in western populations. In addition, there are no western series on the magnifying endoscopic features in AIG. This study presents a cohort of 63 patients with AIG, reporting their clinical, laboratory, and endoscopic findings.

Patients and methods

A retrospective analysis was conducted on patients diagnosed with AIG at Kingston Health Sciences Centre, Canada, between January 2016 and December 2023. Data collected from medical records included age, sex, presenting symptoms, laboratory findings, endoscopic features, histopathology reports, and concomitant autoimmune diseases.

Results

The study included 63 patients with autoimmune gastritis. Positive anti-parietal cell antibodies were found in the majority of patients (84.13%), whereas positive anti-intrinsic factor antibodies were less prevalent (25.40%). Deficiencies in vitamin B12 (49.21%) and iron (76.19%) were observed, along with a high prevalence of anemia (71.43%) and concomitant autoimmune diseases (58.73%). The dominant magnification pattern of atrophy in the body was oval/slit in 57.14% of patients (n=36), followed by tubular in 30.16% (n=19) and foveolar in 12.70% (n=8). Prevalence of neoplasia in our study was 42.86% (n=27).

Conclusion

This study offers insights into the clinical, laboratory, and magnifying endoscopic features of patients with AIG. It demonstrates the three main magnifying endoscopic appearances of AIG and highlights the significant prevalence of gastric neoplasia, even in the low-risk Western population. These findings emphasize the importance of the endoscopic exam in identifying AIG and notably present the key magnifying endoscopy findings in a Western setting for the first time.

Genetic Polymorphism in Alcohol Metabolism and Drinking Behavior Are Associated with Gastric Cancer Risk in Men

Objective In recent years, there has been a growing focus on health risks associated with alcohol consumption. The present study investigated whether or not the genetic variant of aldehyde dehydrogenase 2 (ALDH2) influences the risk of gastric cancer among individuals identified as hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT), which provides a comprehensive assessment of hazardous drinking behavior. Patients We enrolled men with hazardous drinking behavior (AUDIT score ≥8) who had undergone gastric cancer screening (either endoscopy or a barium X-ray examination of the upper gastrointestinal tract) between April 2013 and March 2020 within 1 year from entry and who had subsequently undergone at least one more gastric cancer screening up to March 2021. Functional single-nucleotide polymorphisms of ALDH2 (rs671) were measured using a direct TaqMan polymerase chain reaction method with unprocessed saliva. Results A total of 246 men were enrolled, comprising 193 individuals with active ALDH2 (ALDH2*1/*1) and 53 with less-active ALDH2 (ALDH2*1/*2). The cumulative incidence of gastric cancer in the less-active group was higher than in the active ALDH2 group (p=0.01, hazard ratio: 4.6, 95% confidence interval: 1.2-16.7). Alcohol consumption was lower in the less-active ALDH2 group than in the active ALDH2 group, although no marked difference was observed in the AUDIT score. Conclusion In individuals with hazardous drinking behavior, a heightened risk of gastric cancer was observed among those with less-active ALDH2 variants, even when their alcohol consumption was comparatively lower than in those with active ALDH2 variants.

Efficacy of Rifabutin-Based Helicobacter pylori Eradication Regimen in Korea With High Prevalence of Tuberculosis Infection

BACKGROUND

As the antibiotic resistance and treatment failure rates of Helicobacter pylori are rising, the need for rescue therapy with rifabutin for H. pylori eradication (HPE) is also increasing. Therefore, in this study, we investigated the efficacy, resistance status, and adverse events in patients receiving rifabutin-based HPE.

MATERIALS AND METHODS

Between January 2020 and December 2022, 3006 patients underwent esophagogastroduodenoscopy (EGD) with H. pylori culture tests. Of these, culture results were successfully obtained from 1792 patients, who were subsequently enrolled in our study. The medical records of these patients were retrospectively reviewed, and their clinical features and outcomes assessed.

RESULTS

Among the 1792 patients, 14 (0.8%) were rifabutin-resistant. A total of 665 (37.1%) patients had multidrug-resistant (MDR) H. pylori infections. Patients with rifabutin-resistant H. pylori infections had a significantly higher rate of tuberculosis treatment history (2.8% vs. 28.6%, p < 0.001) and MDR H. pylori infections (49.6% vs. 85.7%, p < 0.001) than those in the rifabutin-susceptible H. pylori group. Among the 45 patients who received the rifabutin-based HPE regimen, 44 (97.8%) had MDR H. pylori infection, and 35 (77.8%) underwent rifabutin-based HPE as a third-line treatment or beyond. A total of 31 (68.9%) showed successful eradication. Nineteen (42.2%) patients experienced at least one symptom of adverse events; however, the severity of side effects was mild, and no patient discontinued treatment because of this.

CONCLUSIONS

The rifabutin-based HPE regimen could be an effective and safe treatment method. It is particularly considered a viable therapeutic option for patients who require HPE but have previously failed to respond to multiple HPEs.

Comparisons in Postoperative Endoscopic Findings and Postoperative Weight Change Between Delta-Shaped Anastomosis and Circular-Stapled Anastomosis in Laparoscopy-Assisted Distal Gastrectomy With B-I Reconstruction

BACKGROUND

Laparoscopy-assisted distal gastrectomy (LADG) with Billroth I (B-I) reconstruction is frequently performed for gastric cancer. However, the difference between the circular stapler technique (CS) and delta-shaped anastomosis (DA) remains unclear, especially regarding the postoperative endoscopic physiological findings.

METHODS

Three hundred and one patients including 150 CS patients and 151 DA patients during LADG with B-I reconstruction between 2013 and 2019 at Saitama Medical University International Medical Center were chosen as study subjects. Postoperative endoscopic findings (1-year post-surgery) in the remnant stomach were evaluated according to the residue, gastritis, and bile-reflux classification, and the first-year postoperative weight changes were also recorded.

RESULTS

The incidences of Grade 2 or higher remnant gastritis, bile reflux, and postoperative exacerbated reflux esophagitis were significantly higher in the DA group, while the amount of residual food was higher in the CS group. Multivariate analysis also revealed the higher risks of Grade 2 or higher gastritis and the postoperative existence or exacerbation of erosive reflux esophagitis in the DA group (OR [95% CI] was 2.737 [1.566-4.783], 3.533 [1.101-11.34], and 3.749 [1.021-13.76], respectively). However, none of these endoscopic differences but the broader extent of gastritis was the only endoscopic factor associated with severe postoperative weight loss.

CONCLUSION

There was a trend toward more exacerbation of residual gastritis and reflux esophagitis with the DA technique and more food remnants with the CS technique. Although the difference in the anastomotic technique did not directly result in weight loss, attention should be paid to prevent extensive residual gastritis.

Comparative efficacy of Helicobacter pylori eradication therapy between tegoprazan-based concomitant and bismuth quadruple therapies: A real-world evidence

BACKGROUND AND AIM

Tegoprazan, a potassium-competitive acid blocker, can be used as a substitute for proton pump inhibitors in Helicobacter pylori eradication therapy; some studies have reported improved efficacy. In Korea, where clarithromycin resistance rates are high, we aimed to compare the efficacies of tegoprazan-based concomitant and bismuth quadruple therapies.

METHODS

We retrospectively analyzed data from patients with H. pylori infection who received either 10-day tegoprazan-based concomitant therapy or 14-day tegoprazan-based bismuth quadruple therapy as first-line treatment. The primary outcome was H. pylori eradication rate, with secondary outcomes including adverse events and insufficient medication rates.

RESULTS

Among the 1082 patients included in the study, 620 and 462 were treated with tegoprazan-based concomitant and bismuth quadruple therapies, respectively. Intention-to-treat analysis demonstrated no difference in eradication rates between the tegoprazan-based concomitant and bismuth quadruple therapy groups (74.7% [95% confidence interval-CI, 71.1-78.0%] vs 74.7% [95% CI, 70.6-78.5%], P = 0.999). Per-protocol analysis also showed similar eradication rates between the two groups (88.0% [95% CI, 85.0-90.6%] vs 89.7% [95% CI, 86.3-92.5%], P = 0.424). The overall adverse event rates (49.6% vs 39.2%, P = 0.001) and insufficient medication rates (4.8% vs 2.4%, P = 0.036) were higher in the bismuth quadruple therapy group than in the concomitant therapy group.

CONCLUSIONS

The eradication rates of tegoprazan-based 10-day concomitant therapy and 14-day bismuth quadruple therapy were comparable. However, because of its shorter treatment duration, better medical adherence, and lower incidence of adverse events, tegoprazan-based concomitant therapy may be preferable in regions with high rates of clarithromycin and metronidazole resistance.

Young Patient with X-linked Agammaglobulinemia Presents with Advanced Gastric Cancer and Extensive Atrophic Gastritis

X-linked agammaglobulinemia (XLA) is associated with an increased risk of gastrointestinal cancers including gastric cancer (GC). We herein report the case of a 30-year-old male patient with XLA who developed GC and extensive atrophic gastritis. He tested positive in the urea breath test, thus indicating the presence of Helicobacter pylori. Distal gastrectomy and chemotherapy were performed without any complications; however, the died two years after this diagnosis. Immunoglobulin deficiency makes these patients susceptible to progressive atrophic gastritis and the associated risk of GC. Therefore, patients with XLA are advised to undergo an evaluation for Helicobacter pylori infection as well as monitoring for GC.

Distinct microbiome dysbiosis and epigenetic anomaly in esophageal adenocarcinoma and its underlying Barrett's esophagus

Interaction between host genotoxic changes and mucosa-associated microbiome (MAM) dysbiosis may have a role in various digestive cancers. We investigated MAM in Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) progression sequence and its association with host genotoxic changes. 16S rRNA gene sequencing was performed in three different groups of biopsies from nonneoplastic BE from patients without cancer (N, normal group; n = 47) and with EAC (ADJ, adjacent group; n = 27). Endoscopic biopsies were also obtained from EAC tissues (T, tumor group; n = 22). Results were correlated with TP53 mutation, telomere length and DNA methylation of candidate genes (N33, DPYS, SLC16A12, miR124A3 and miR34bc). Genome-wide DNA methylation examined by reduced representation bisulfite sequencing (RRBS) was available for 32 samples (n = 12 for N, n = 12 for ADJ and n = 22 for T groups). Lower microbial alpha diversity measures were observed in ADJ/T groups relative to N group and associated with higher mean Z score DNA methylation of candidate genes. Specific genera (n = 16) with significant change between ADJ/T groups relative to N group occurred mostly in ADJ group (13/16) and half of them (8/16) were associated with DNA methylation status. Integrated MAM and genome-wide methylation analysis demonstrated that hyper-methylated sites, associated with lower alpha diversity measures dominantly occurred within near the transcription start site, codifying genes were involved in metabolic processes. Our result shows that microbial dysbiosis in EAC mostly occurs in adjacent BE and such dysbiosis was associated with DNA methylation status, offering support for a pathogenic role of interaction between host genotoxic changes and MAM in this tumor type.

Endoscopic and Histological Characteristics of Gastric Cancer Detected Long After Helicobacter pylori Eradication Therapy

BACKGROUND/OBJECTIVES

Since 2013, eradication therapy for Helicobacter pylori gastritis (Hp-ET) has been covered by the National Health Insurance of Japan. Recently, the risk of post-eradication gastric cancer (pE-GC) has increased. pE-GC includes cancers that develop immediately and several years after Hp-ET. Therefore, we aimed to clarify the endoscopic and histological characteristics of late types of pE-GCs.

METHOD

One hundred patients with differentiated cancers detected after Hp-ET who underwent endoscopic submucosal dissection from 2015 to 2023 were compared. Patients were divided into two groups; the immediate group (n = 69), with cancer detected within 6 years, and the delayed group (n = 31), with cancer detected within >6 years after Hp-ET. The background mucosa and tumor mucosa were examined individually. The endoscopic findings were as follows: enlarged folds, map-like redness, intermediate zone irregularity, and the presence of a regular arrangement of collecting venules and a light blue crest (background); an irregular surface structure, an irregular vascular pattern, an irregular surface pattern, and a gastritis-like appearance (tumor). The histological findings were as follows: a low remnant rate of the fundic glands, intestinal metaplasia (IM), crypt enlargement, and neutrophil infiltration (background); mosaicism, the elongation of noncancer ducts, and an overlying non-neoplastic epithelium (tumor).

RESULTS

There was no significant difference regarding the background mucosa and tumor mucosa between the two groups. In the delayed group, the remnant rate of the fundic glands was 19.8 ± 15.6%, and IM was 87.1% (27/31). Further, 90.3% (28/31) of the patients exhibited persistent neutrophil infiltration.

CONCLUSION

This study suggested that patients with a low remnant rate of the fundic gland and IM and persistent mucosal inflammation were at high risk for developing pE-GCs.

The endoscopic model for gastric carcinogenesis and Helicobacter pylori infection: A potential visual mind-map during gastroscopy examination

Helicobacter pylori (Hp) is the main trigger of chronic gastric atrophy and the main leading cause of gastric cancer. Hp infects the normal gastric mucosa and can lead to chronic inflammation, glandular atrophy, intestinal metaplasia, dysplasia and finally adenocarcinoma. Chronic inflammation and gastric atrophy associated with Hp infection appear initially in the distal part of the stomach (the antrum) before progressing to the proximal part (the corpus-fundus). In recent years, endoscopic developments have allowed for the characterization of various gastric conditions including the normal mucosa (pyloric/fundic gland pattern and regular arrangement of collecting venules), Hp-related gastritis (Kyoto classification), glandular atrophy (Kimura-Takemoto classification), intestinal metaplasia (Endoscopic Grading of Gastric Intestinal Metaplasia), and dysplasia/adenocarcinoma (Vessel plus Surface classification). Despite being independent classifications, all these scales can be integrated into a single model: the endoscopic model for gastric carcinogenesis. This model would assist endoscopists in comprehending the process of gastric carcinogenesis and conducting a systematic examination during gastroscopy. Having this model in mind would enable endoscopists to promptly recognize the implications of Hp infection and the potential patient's risk of developing gastric cancer.

Novel Endoscopic Findings of Lesions with a Short White Hair-like Appearance in the Lower Esophagus

Objective The presence of a short white hair-like appearance in the lower esophagus has recently been noted during esophagogastroduodenoscopy (EGD) at our institution. Histological findings showed that this formation was a spiked protrusion of the esophageal papilla. The results regarding the prevalence of such lesions in individuals who underwent EGD examinations as part of medical checkup procedures are herein presented. Methods The EGD results of 14,338 individuals (9,225 males, 5,113 females; mean age 54.0±9.8 years) were examined. The findings related to the presence of multiple lesions with a short white hair-like appearance in the lower esophagus of patients with reflux esophagitis, esophageal squamous papilloma, or gastric mucosal atrophy (GMA), as well as the hiatal hernia width, were investigated. Results Endoscopic findings indicating short white hair-like appendages in the lower esophagus were noted in 167 patients, with a prevalence rate of 1.2%. A female sex, younger age, lower body mass index, lower percentages of habitual smoking and drinking, and the presence of esophageal squamous papilloma were characteristic features of cases with such findings. In addition, a significantly lower prevalence of reflux esophagitis and a smaller diaphragmatic hiatus size were observed. A multiple logistic regression analysis indicated that a female sex, absence of reflux esophagitis, presence of esophageal squamous papilloma, and a smaller diaphragmatic hiatus were factors significantly related to the presence of these short white hair-like appendages. An analysis of circumferential localization revealed the main location to be the left-posterior wall. Conclusion This study is the first to report the prevalence of multiple short white hair-like appendages in the lower esophagus. The occurrence of such lesions is inversely associated with the presence of reflux esophagitis.

High neutrophil-to-lymphocyte ratio at Helicobacter pylori eradication increases the risk of eradication failure and post-eradication gastric cancer

INTRODUCTION

Vonoprazan has been known to have a high Helicobacter pylori (H. pylori) eradication rate since its launch in 2015. Yet, the risk factors for eradication failure and development of post-eradication gastric cancer (GC) using VPZ regimen remain unclear.

METHODS

This single-center cohort study included 934 consecutive patients who underwent H. pylori eradication using VPZ between February 2015 and June 2017 and were followed up for five years by the end of 2022. We examined several indicators of systemic immune, inflammatory, and nutritional status at the time of eradication to identify those indicators could predict eradication success, risk of post-eradication GC development, and long-term prognosis.

RESULTS

The successful eradication rates were 92.6% (intention-to-treat) and 98.7% (per-protocol). Multivariate analysis showed that only a high peripheral blood neutrophil-to-lymphocyte ratio (NLR) was significantly associated with eradication failure. The 5-year GC incidence rate was 1.67%, and all GCs were stage IA. The mean (standard deviation [SD]) time from eradication to diagnosis was 40.5 (6.1) months. Multivariate analysis showed that high NLR and history of GC and hypertension were significantly associated with GC development. Patients with elevated NLR post-eradication had a higher risk of newly developed GC. Twelve patients died during the study period, and a high NLR was associated with a significantly higher mortality rate.

CONCLUSIONS

NLR has the potential to be a biomarker that predicts the failure of eradication and development of post-eradication GC. High NLR was also associated with poor long-term prognosis after H. pylori eradication.

A Study of the Risk Factors for 402 Patients with Esophageal Squamous Cell Carcinoma - A Retrospective Comparison with Health Checkup Participants

Objective Esophageal cancer is a gastrointestinal cancer with a poor prognosis. However, it is curable and can be treated endoscopically if it is detected at an early stage. The objective of this study was to identify the factors that contribute to early detection. Methods From April 2011 to December 2019, we retrospectively investigated consecutive patients diagnosed with esophageal squamous cell carcinoma (ESCC) through upper gastrointestinal endoscopy at two hospitals of Kawasaki Medical University based on medical records. The factors contributing to the early detection of ESCC were investigated by comparing patients with ESCC with those undergoing health checkups in whom no organic lesions were found in the upper gastrointestinal tract on endoscopy (controls). Patients Factors contributing to early detection were examined in 402 ESCC cases and 391 sex- and age-matched controls, and early and advanced cancers were compared along with the risk factors for ESCC. Results A multivariate analysis showed that alcohol consumption and smoking, concomitant cancer of other organs, and a low body mass index (BMI) were factors associated with ESCC (odds ratio [OR], 4.65; 95% confidence interval [CI], 2.880-7.520, OR, 3.63; 95% CI, 2.380-5.540, OR, 2.09; 95% CI, 1.330-3.270, OR, 6.38; 95% CI, 3.780-10.800), whereas dyslipidemia was significantly less common in patients with ESCC (OR, 0.545; 95% CI, 0.348-0.853). Comparing early and advanced cancers, a history of endoscopic screening was the only factor involved in early detection (OR, 7.93; 95% CI, 4.480-14.000). Conclusion The factors associated with ESCC include alcohol consumption, smoking, concomitant cancer of other organs, and a low BMI. Endoscopy in subjects with these factors may therefore be recommended for the early detection of ESCC.

Effects of Medication Period and Gastrin Levels on Endoscopic Gastric Mucosal Changes in Long-Term Proton Pump Inhibitor Users

Background/Objectives: Proton pump inhibitor (PPI) use has increased worldwide, including in continuous and longer-term users. Recent reports highlight PPI-related endoscopic gastric mucosal changes, including fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cracked and cobblestone-like mucosa (CCLM), and black spots. PPI use elevates gastrin levels because of acid inhibition, and hypergastrinemia might be relevant to these findings. In this cross-sectional study, we retrospectively examined gastric mucosal changes in long-term PPI users, focusing on medication period and gastrin levels. Methods: We enrolled 57 patients who received a PPI (>1 year) at two clinics between January 2021 and March 2022. Participants were classified according to medication period: 1 < 5, 5-10, and ≥10 years. Gastrin levels were categorized as low, middle, and high (<250, 250-500, and ≥500 pg/mL, respectively). Odds ratios (OR) were estimated to assess the risk of endoscopic findings. Results: Of the 57 patients, 6 (10.5%), 25 (43.9%), and 26 (45.6%) were PPI users of 1 < 5, 5-10, and ≥10 years, respectively. There were no significant differences in the incidence of endoscopic findings among the medication periods. Low, middle, and high gastrin groups included 21 (36.8%), 21 (36.8%), and 15 (26.3%) patients, respectively. CCLM incidence was significantly elevated in higher gastrin level groups: middle (OR, 6.60; 95% confidence interval [CI], 1.46-29.75; p = 0.014) and high (OR, 9.00; 95% CI, 1.79-45.23; p = 0.0008) (p-trend = 0.0171). No significant differences were observed for other findings. Conclusions: No elevated risk of PPI-related gastric epithelial changes in long-term PPI users was observed time-dependently. Notably, higher gastrin levels were positively associated with CCLM development, irrespective of the medication period.

Analysis of clinicopathological factors associate with the visibility of early gastric cancer in endoscopic examination and usefulness of linked color imaging: A multicenter prospective study

BACKGROUND

This study investigated clinicopathological factors associated with the visibility of early gastric cancer and the efficacy of linked color imaging.

METHODS

Patients with early gastric cancer who underwent endoscopic treatment between April 2021 and July 2022 were enrolled. All cases underwent white light imaging and linked color imaging. Three experts evaluated lesion visibility using a visual analog scale. A mean score ≥3 on white light imaging was defined as "good visibility", and <3 as "poor visibility". We extracted patient information and endoscopic and pathological data for the lesion and background mucosa, analyzed factors associated with the visibility of early gastric cancer, and compared visibility between white light imaging and linked color imaging.

RESULTS

Ninety-seven lesions were analyzed, with good visibility in 49 and poor visibility in 48. Multivariate analysis revealed small lesion size (odds ratio 1.89) and presence of endoscopic intestinal metaplasia (odds ratio 0.49) as significantly associated with the poor visibility of early gastric cancer. Mean visibility score was significantly higher for linked color imaging (P<0.001). Mean score for linked color imaging was significantly higher in the poor visibility group (P<0.001), but not significantly different in the good visibility group (P = 0.292). Mean score was significantly higher with linked color imaging in cases with endoscopic intestinal metaplasia (P = 0.0496) and lesions <20 mm in diameter (<10 mm, P = 0.002; 10-20 mm, P = 0.004).

CONCLUSIONS

Lesion size and endoscopic intestinal metaplasia are associated with the visibility of early gastric cancer in white light imaging. Linked color imaging improves visibility of gastric cancer with these factors.

A Proton Pump Inhibitor Independently Elevates Gastrin Levels as a Marker for Metachronous Gastric Cancer After Endoscopic Submucosal Dissection

Background and Objective: Serum markers such as gastrin and pepsinogen are useful for stratifying gastric cancer risk. However, their utility in predicting metachronous gastric cancer after endoscopic submucosal dissection (ESD) in patients with gastric cancer after Helicobacter pylori eradication (GCAE) is unclear. This study aimed to clarify predictive factors for metachronous gastric cancer after ESD with a focus on serum markers. Methods: A retrospective analysis was conducted on 197 patients with 224 GCAE lesions who underwent ESD at Hiroshima University Hospital between April 2010 and December 2019. In total, 63 patients with 74 differentiated-type lesions were classified into metachronous gastric cancer (MG) and non-metachronous gastric cancer (NMG) groups, excluding proton pump inhibitor (PPI) users, female patients, and undifferentiated-type cases. The predictive value of serum markers was assessed using ROC curve analysis, and their association with carcinogenesis was evaluated using multiple logistic regression. Furthermore, the incidence of MG was compared between long-term PPI users and non-users. Results: ROC analysis revealed that serum gastrin had the highest discriminative ability for MG (AUC 0.77, cut-off 99 pg/mL, sensitivity 61.6%, and specificity 80.0%). Severe mucosal atrophy and high gastrin levels were significantly more common in the MG group and were independent predictors (p < 0.01). Although serum gastrin levels were significantly elevated in PPI users, no increased risk of MG was observed. Conclusions: In addition to severe mucosal atrophy, PPI-independent elevated serum gastrin levels may be associated with an increased risk of MG after ESD. Serum gastrin may serve as a valuable marker for post-ESD cancer surveillance in GCAE patients.

Efficacy and safety of tegoprazan- and rabeprazole-based concomitant therapies for Helicobacter pylori infection: Real-world evidence

BACKGROUND AND AIM

Tegoprazan, a novel potassium-competitive acid blocker, has been approved for Helicobacter pylori eradication in Korea. We compared the efficacy and safety of tegoprazan- and rabeprazole-based concomitant therapies for H. pylori eradication in real-world clinical practice.

METHODS

We retrospectively analyzed data from patients with H. pylori infection treated with tegoprazan- or rabeprazole-based concomitant therapies. The primary endpoint was H. pylori eradication rate. The secondary endpoint was adverse events.

RESULTS

Among the 1474 included patients, 620 and 854 received tegoprazan- and rabeprazole-based concomitant therapies, respectively. Intention-to-treat analysis showed no significant difference in the eradication rates between the tegoprazan- and rabeprazole-based concomitant therapy groups (74.7% [95% confidence interval [CI], 71.1-78.0%] vs 72.7% [95% CI, 69.7-75.6%], P = 0.400). Per-protocol analysis also demonstrated similar eradication rates for the groups (tegoprazan vs rabeprazole: 88.0% [95% CI, 85.0-90.6%] vs 85.9% [95% CI, 83.2-88.3%], P = 0.288). Although the overall adverse event rate did not differ between groups (tegoprazan vs rabeprazole, 39.2% vs 40.6%, P = 0.578), abdominal discomfort was less frequent in the tegoprazan group than in the rabeprazole group (1.3 vs 4.8%, P = 0.001).

CONCLUSIONS

Tegoprazan- and rabeprazole-based concomitant therapies for H. pylori eradication showed comparable efficacy and overall safety. The effect of tegoprazan on dose increases or other regimens, such as bismuth-containing quadruple therapy, should be further evaluated, because the efficacy of tegoprazan-based concomitant therapy may be suboptimal in regions where the clarithromycin resistance rate is high.

Endoscopic and Histological Gastritis in University Students with Helicobacter pylori Infection

Objective Although the characteristics of Helicobacter pylori infection have been extensively reported, there is a lack of consensus regarding its characteristics in young adults. The present study examined the endoscopic and histological characteristics of young adults who underwent eradication therapy for H. pylori infection. Methods We examined the H. pylori infection status of first-year students at Okayama University School of Medicine and Dentistry between 2014 and 2020. A total of 152 (6.8%) students who were positive for H. pylori antibody or pepsinogen tests were enrolled in the study. Among them, 107 students underwent endoscopy, and their biopsy samples were investigated. Seventy-five students were diagnosed with H. pylori infections. Results Of 75 H. pylori-positive patients, 57 (76.0%) had endoscopic atrophic gastritis, and 42 (56.0%) had histological atrophy. A few patients had severe atrophic gastritis. All 65 patients who underwent an eradication assessment were successfully treated. After successful eradication, 26 patients underwent endoscopic follow-up. The mean follow-up period was 32.9 months. A histological evaluation revealed that gastric antrum atrophy had subsided in 11 of 14 patients, and atrophy in the lesser curvature of the gastric body had subsided in 7 of 8 patients. Conclusion More than half of young adults with H. pylori infection had atrophic gastritis. We found mild atrophy in young adults, which subsided shortly after eradication treatment. This study provides a foundation for future studies to evaluate the validity of eradication therapy in preventing gastric cancer in patients.

Correlation of gastrointestinal symptom rating scale and frequency scale for the symptoms of gastroesophageal reflux disease with endoscopic findings

BACKGROUND

Gastroesophageal Reflux Disease (GERD) is caused by the reflux of gastric contents into the esophagus and has a 13% global prevalence that is increasing. GERD symptoms negatively impact physical, social, and emotional quality of life. The Frequency Scale for the Symptoms of GERD (FSSG) and the Gastrointestinal Symptom Rating Scale (GSRS) determine the efficacy of treatment but may not correlate with endoscopically estimated esophageal mucosal injury severity. We aimed to probe the correlation between FSSG, GSRS, and esophageal injury severity to evaluate whether these scores can predict GERD severity.

METHODS

A total of 2962 patients who underwent physical examinations, including upper gastrointestinal endoscopy, at the Kyoto Kuramaguchi Medical Center, Japan, were enrolled in this study. Upper gastrointestinal endoscopy was used to diagnose fundic mucosal atrophy, reflux esophagitis based on the Los Angeles (LA) classification, gastroesophageal flap value function (GEFV) based on Hill's classification, and Barrett's esophagus. Endoscopic diagnoses were examined for correlations with FSSG and GSRS scores.

RESULTS

In reflux esophagitis, FSSG and GSRS scores correlated with LA-B and LA-C endoscopic diagnosis but not with LA-M and LA-A endoscopic findings. Multiple regression analysis results were similar. FSSG scores reflected advanced fundic gland mucosal atrophy, while GSRS scores associated with high grade of GEFV.

CONCLUSIONS

This is the first report to examine the correlation between FSSG and GSRS scores and endoscopic findings in a relatively large patient population. Our findings suggest that these scores can diagnose the severity of reflux esophagitis.

Map-Like Redness Development After Eradication Therapy for Helicobacter pylori Infection: Prospective Multicenter Observational Study

BACKGROUND

Map-like redness, pathological intestinal metaplasia, is observed in one-fourth to one-third of patients 1 year after Helicobacter pylori eradication therapy, mainly in the corpus, and is a newly identified endoscopic risk factor for gastric cancer development after eradication. However, it is unclear whether intestinal metaplasia is present before eradication at the site where the map-like redness appears. We aimed to identify endoscopic findings that predict the occurrence of map-like redness before H. pylori eradication.

MATERIALS AND METHODS

As a prospective multicenter trial, the characteristics of patients in whom map-like redness developed after eradication, and the association between the endoscopic severity of gastritis and the development of map-like redness in patients who underwent endoscopy before and 1-year after eradication were investigated.

RESULTS

The rate of map-like redness in all 93 patients 1-year postsuccessful eradication was 30.1% (95% confidence interval [CI]: 21.0-40.5). All patients with map-like redness were endoscopically observed to have intestinal metaplasia before eradication, in the site that subsequently developed map-like redness. Patients who developed map-like redness were older, had more severe intestinal metaplasia and nodularity and a higher total score on the Kyoto Classification of Gastritis both before and after eradication than patients who did not. On multivariate analysis, map-like redness was found to be associated with posttreatment intestinal metaplasia (odds ratio: 8.144; 95% CI: 2.811-23.592).

CONCLUSIONS

In all patients who developed map-like redness after eradication, endoscopic intestinal metaplasia was observed at the site developed map-like redness before eradication therapy. Map-like redness was especially observed in patients with more severe intestinal metaplasia at 1-year after eradication. Such patients require increased attention at surveillance endoscopy, owing to generally having a higher risk of gastric cancer development.

TRIAL REGISTRATION

University Hospital Medical Information Network: UMIN000044707.

Classification of fundic gland polyps for predicting gastric neoplasms in Helicobacter pylori-negative patients with familial adenomatous polyposis

BACKGROUND

In familial adenomatous polyposis (FAP) patients, fundic gland polyps (FGPs) have been considered a risk factor for gastric neoplasms. We speculated that FGPs in FAP patients spread directionally from the greater to the lesser curvature of the gastric body and investigated the relationship between the distribution of FGPs and gastric neoplasm development.

METHODS

We extracted 195 FAP patients from two institutions and reviewed their medical records. Gastric polyposis was classified based on the FGP distribution (P0, no FGPs; P1, localized in the fundus or greater curvature of the gastric body; P2, spreading to the anterior or posterior wall; P3, involving the proximal half of the lesser curvature; and P4, spreading from P3 to the anal side of the lesser curvature).

RESULTS

The 195 eligible patients were divided into the neoplasm group (n = 54, 28%) and the non-neoplasm group (n = 141, 72%). Overall, 24% of the patients were Helicobacter pylori (H. pylori)-positive. In the FGP distribution, the rate of patients with gastric neoplasm tended to increase significantly with each step towards an increasingly wide distribution from P0 to P4 in H. pylori-negative patients, but not in H. pylori-positive ones. In addition, in H. pylori-negative patients, the likelihood of neoplasm increased consistently from P0 to P4, with the highest odds ratio (95% confidence interval) at P4 of 14.1 (2.5-154.4). Furthermore, multivariate analysis showed P4 and Spigelman stage ≥III were significantly associated with gastric neoplasm development.

CONCLUSION

FGP distribution was correlated with gastric neoplasm development in FAP patients.

Comparison of Effective Imaging Modalities for Detecting Gastric Neoplasms: A Randomized 3-Arm Phase II Trial

INTRODUCTION

The early detection of gastric neoplasms (GNs) leads to favorable treatment outcomes. The latest endoscopic system, EVIS X1, includes third-generation narrow-band imaging (3G-NBI), texture and color enhancement imaging (TXI), and high-definition white-light imaging (WLI). Therefore, this randomized phase II trial aimed to identify the most promising imaging modality for GN detection using 3G-NBI and TXI.

METHODS

Patients with scheduled surveillance endoscopy after a history of esophageal cancer or GN or preoperative endoscopy for known esophageal cancer or GN were randomly assigned to the 3G-NBI, TXI, or WLI groups. Endoscopic observations were performed to detect new GN lesions, and all suspected lesions were biopsied. The primary endpoint was the GN detection rate during primary observation. Secondary endpoints were the rate of missed GNs, early gastric cancer detection rate, and positive predictive value for a GN diagnosis. The decision rule had a higher GN detection rate between 3G-NBI and TXI, outperforming WLI by >1.0%.

RESULTS

Finally, 901 patients were enrolled and assigned to the 3G-NBI, TXI, and WLI groups (300, 300, and 301 patients, respectively). GN detection rates in the 3G-NBI, TXI, and WLI groups were 7.3, 5.0, and 5.6%, respectively. The rates of missed GNs were 1.0, 0.7, and 1.0%, the detection rates of early gastric cancer were 5.7, 4.0, and 5.6%, and the positive predictive values for the diagnosis of GN were 36.5, 21.3, and 36.8% in the 3G-NBI, TXI, and WLI groups, respectively.

DISCUSSION

Compared with TXI and WLI, 3G-NBI is a more promising modality for GN detection.

Cancer risk by length of Barrett's esophagus in Japanese population: a nationwide multicenter retrospective cohort study

BACKGROUND

The cancer risk for each length of Barrett's esophagus (BE) in Japanese is unknown. This nationwide, multi-institutional study aims to clarify the cancer risk by length of BE in the general Japanese population.

METHODS

Consecutive subjects who underwent upper endoscopic screening at 17 centers between 2013 and 2017 and had at least one follow-up endoscopy by December 2022 were included. The presence/absence of BE and, if present, its length were retrospectively assessed using the retrieved endoscopic images recorded at baseline. Information on the subsequent occurrence of esophageal adenocarcinoma and other upper gastrointestinal cancers was also collected. Cancer incidence was calculated and expressed as %/year.

RESULTS

A total of 33,478 subjects were enrolled, and 17,884 (53.4%), 10,641 (31.8%), 4889 (14.6%), and 64 (0.2%) were diagnosed as absent BE, BE < 1 cm, 1-3 cm, and ≥ 3 cm, respectively. During a median follow-up of 80 months, 11 cases of esophageal adenocarcinoma developed. The annual incidence of esophageal adenocarcinoma is 0%/year for absent BE, 0.0032 (0.00066-0.013)%/year for BE < 1 cm, 0.026 (0.011-0.054)%/year for 1-3 cm, and 0.58 (0.042-2.11)%/year for ≥ 3 cm, respectively. Meanwhile, the incidence of esophageal squamous cell carcinoma and gastric cancer were 0.039 (0.031-0.049)%/year and 0.16 (0.14-0.18)%/year, respectively.

CONCLUSIONS

By enrolling a large number of subjects with long-term follow-up, this study demonstrated that the risk of cancer increased steadily with increasing length of BE in the Japanese population. Therefore, it is important to consider the length of BE when determining the management strategy for BE.

Adenocarcinoma of the esophagogastric junction: characteristics of female patients and young adult patients based on a 12-year retrospective and prospective multicenter clinicoepidemiological cohort study in Japan

BACKGROUND

Adenocarcinoma of the esophagogastric junction (AEGJ) is most common in men and the elderly, but the disease is becoming more common in female and young adult persons. We have investigated the clinicoepidemiological characteristics of female and young adult patients with AEGJ and the 12-year trends in the Kurashiki area for young adult patients with AEGJ.

METHODS

Patients diagnosed with AEGJ in 12 hospitals between January 2008 and December 2019 were included in this study. Patients were divided into three groups by age (young adult [≤50 years], middle-aged [51 to 70 years], and elderly [>70 years]). Factors associated with AEGJ such as obesity, smoking, hiatal hernia and male, which were reported in our previous study, were identified.

RESULTS

One hundred and eighty-eight AEGJ patients, including 36 females and 20 young adults, were characterized. There was no significant change in the annual incidence of AEGJ among female (p=0.078) and young adult patients (p=0.89). Female patients without any associated factors, accounting for 53% (19/36) of the female patients and young adult patients, had significantly more histologically undifferentiated cancers than patients with at least one associated factor (58% [11/19] vs. 30% [50/169], p=0.025) and middle-aged and elderly patients (60% [12/20] vs. 30% [25/83] vs. 28% [24/85], p =0.026). Smoking was significantly less common in women than in men (8% [3/36] vs. 57% [87/152], p < 0.01). There were no significant differences between ages in the proportions of these associated factors.

CONCLUSIONS

Histologically undifferentiated AEGJ cancers were more frequent in female patients without any associated factors and in young adult patients. Factors associated with AEGJ may differ between women and men, but they are similar in young adults and older adults. No increase in young adult patients with AEGJ was observed in the 12-year study.

Role of submucosal injection in radiofrequency ablation of gastric low-grade dysplasia: Effects on symptoms and outcomes

BACKGROUND

To date, there is still a lack of standardized management strategies for gastric low-grade dysplasia (LGD), which is a direct neoplastic precancerous lesion and requires specifically superficial destruction. Radiofrequency ablation (RFA) is expected to be an effective method for gastric LGD, but post-RFA pain may affect patients' satisfaction and compliance. The current study aimed to evaluate the value of a submucosal injection prior to RFA (SI-RFA) for postoperative pain and treatment outcomes.

METHODS

Between October 2014 and July 2021, gastric LGDs without risk factors (size >2 cm, unclear boundary, and abnormal microsurface and microvascularity) undergoing regular RFA and SI-RFA were retrospectively analyzed. Postoperative pain scores, wound healing, and clinical efficacy were compared. Propensity score matching, stratified analysis, and multivariable logistic regression were performed to control the confounding variables.

RESULTS

One hundred and ninety-seven gastric LGDs in 151 patients received regular RFA. Forty-nine gastric LGDs in 36 patients received SI-RFA. Thirty-six pairs of patients were selected for the assessment of postoperative pain by propensity score matching. Compared to regular RFA, SI-RFA significantly decreased the degree and duration of postoperative pain (OR, 0.32; 95% CI, 0.13-0.84; P = 0.020), improved wound healing rate (80.0% [36/45] vs . 58.9% [89/151], P = 0.012), increased the complete ablation rate (91.8% [45/49] vs . 86.3% [170/197], χ2 = 1.094, P = 0.295), but correlated with higher rates of local recurrence and progression (25.6% [10/39] vs . 13.2% [18/136], χ2 = 3.471, P = 0.062; 8.3% [3/36] vs . 0.9% [1/116], P  = 0.042). The multivariable logistic regression model confirmed that submucosal injection was associated with local recurrence (OR, 2.93; 95% CI, 1.13-7.58; P = 0.027).

CONCLUSIONS

Submucosal injections prior to RFA may reduce postoperative pain and scar formation while ensuring complete ablation of gastric LGD. However, local recurrence and progression should be considered seriously.

Long-term outcome of regional cooperation pathway after endoscopic submucosal dissection for early detection of new gastric cancer

OBJECTIVES

The Cancer Control Act requires the maintenance of regional cooperation pathways (RCP) for cancer treatment. In 2008, we started RCP for early detection of new gastric cancer after endoscopic submucosal dissection (ESD). In gastric cancer treatment, RCP after surgical resection had been widely used, but little is known about RCP after ESD. This study aimed to evaluate the effectiveness of RCP after ESD.

METHODS

This study included 465 patients on whom our RCP was implemented from 2008 to 2018. A regional family physician performed surveillance endoscopy at 3 months and 1 year after ESD and annually thereafter. We retrospectively evaluated the cumulative incidence and treatment outcomes of new gastric cancer and compared them with previous reports.

RESULTS

During a median follow-up period of 70.5 months (3-120 months), 58 patients developed new gastric cancers, and metachronous gastric cancer was detected in 55 patients more than 1 year after ESD. The 5-year cumulative incidence rate was 9.8%. Three patients did not want treatment. Among the remaining 55 patients, the initial treatment was ESD in 51 and surgical resection in 4. Eventually, 50 patients (48 in the ESD group and 2 in the surgical resection group) fulfilled the pathologic criteria for curative ESD. There were no deaths due to gastric cancer.

CONCLUSION

Our study was the first to reveal the incidence of new gastric cancer after ESD using RCP. Most lesions were cured with ESD, and no patients died of gastric cancer. Therefore, we consider RCPs to be an option for surveillance after ESD.

Endoscopic and histological risk stratification for gastric cancer using gastric intestinal metaplasia

BACKGROUND AND AIM

Intestinal metaplasia (IM) of the gastric mucosa is strongly associated with the risk of gastric cancer (GC). This study was performed to investigate the usefulness of endoscopic and histological risk stratification for GC using IM.

METHODS

This was a post-hoc analysis of a multicenter prospective study involving 10 Japanese facilities (UMINCTR000027023). The ridge/tubulovillous pattern, light blue crest (LBC), white opaque substance (WOS), endoscopic grading of gastric IM (EGGIM) score using non-magnifying image-enhanced endoscopy, and operative link on gastric IM assessment (OLGIM) were evaluated for their associations with GC risk in all patients.

RESULTS

In total, 380 patients (115 with GC and 265 without GC) were analyzed. The presence of an LBC (limited to antrum: odds ratio [OR] 2.4 [95% confidence interval 1.1-5.0], extended to corpus: OR 3.6 [2.1-6.3]), the presence of WOS (limited to antrum: OR 3.0 [1.7-5.3], extended to corpus: OR 4.2 [2.1-8.2]), and histological IM (limited to antrum: OR 3.2 [1.4-7.4], extended to corpus: OR 8.5 [4.5-16.0]) were significantly associated with GC risk. Additionally, the EGGIM score (5-8 points: OR 8.8 [4.4-16.0]) and OLGIM (stage III/IV: OR 12.5 [6.1-25.8]) were useful for stratification of GC risk. The area under the receiver operating characteristic curve value for GC risk was 0.740 for OLGIM and 0.706 for EGGIM.

CONCLUSIONS

The LBC, WOS, EGGIM, and OLGIM were strongly associated with GC risk in Japanese patients. This finding can be useful for GC risk assessment in daily clinical practice.