High-definition optical magnification with digital chromoendoscopy detects gastric mucosal changes in dyspeptic-patients

Carlos Robles-Medranda, Manuel Valero, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Miguel Soria-Alcívar, Haydee Alvarado-Escobar, Hannah Pitanga-Lukashok, Carlos Robles-Medranda, Manuel Valero, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Miguel Soria-Alcívar, Haydee Alvarado-Escobar, Hannah Pitanga-Lukashok

Abstract

Background: Accurate detection of gastric infection by Helicobacter pylori (H. pylori) and premalignant lesions are important for effective provision of treatment, preventing the development of gastric neoplasia. Optical enhancement systems with optical magnification improved the identification of mucosal superficial and vascular patterns in patients with dyspepsia.

Aim: To evaluate an optical enhancement system with high-definition magnification, for diagnosis of normal gastric mucosa, H. pylori-associated gastritis, and gastric atrophy.

Methods: A cross-sectional, nonrandomized study from November 2015 to April 2016 performed in a single-tertiary academic center from Ecuador. Seventy-two consecutive patients with functional dyspepsia according to the Rome III criteria, were tested for H. pylori using a stool antigen test and were assigned to an Hp + group or an Hp - control group. Esophagogastroduodenoscopy with high-definition optical magnification and digital chromoendoscopy was performed, and patients were classified into 4 groups, in accordance to the microvascular-architecture pattern of the mucosa. Interobserver and intraobserver agreement among operators were calculated.

Results: Of the 72 participants, 35 were Hp + and 37 were Hp -. Among 10 patients with normal mucosal histology in biopsy samples, 90% had a Type I pattern of microvascular architecture by endoscopy. Among participants with type IIa and type IIb patterns, significantly more were Hp+ than Hp- (32 vs 8), and most (31 out of 40) had histological diagnoses of chronic active gastritis. Two of the three participants with a histological diagnosis of atrophy had a type III microvascular pattern. The type I pattern predicted normal mucosa, type IIa-IIb predicted H. pylori infection, and type III predicted atrophy with sensitivities of 90.0%, 91.4%, and 66.7%, respectively. The intraobserver and interobserver agreements had kappa values of 0.91 and 0.89, respectively.

Conclusion: High-definition optical magnification with digital chromoendoscopy is useful for diagnosis of normal gastric mucosa and H. pylori-associated gastritis with high accuracy, but further studies are needed to determine whether endoscopic diagnosis of gastric atrophy is feasible.

Keywords: Atrophic; Digestive system; Endoscopy; Gastric mucosa; Gastritis; Helicobacter pylori.

Conflict of interest statement

Conflict-of-interest statement: Robles-Medranda C is a key opinion leader for Pentax Medial and Boston Scientific. The other authors declare that they have no conflicts of interest.

©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Flowchart showing the process of classification of the study participants. NSAIDs: Nonsteroidal anti-inflammatory drugs; PPIs: Proton-pump inhibitors; Hp: Helicobacter pylori.
Figure 2
Figure 2
Four microvascular patterns identified by endoscopy of the gastric body mucosa. A: The type I pattern comprises a honeycomb-type subepithelial capillary network (SECN), with a regular arrangement of collecting venules and regular, round pits; B: The type IIa pattern comprises a honeycomb-type SECN with regular, round pits, but with loss of collecting venules; C: In the type IIb pattern, there is loss of the normal SECN and collecting venules, and the presence instead of enlarged white pits surrounded by erythema; D: The type III pattern is characterized by loss of the normal SECN and round pits, with irregular arrangement of the collecting venules.

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Source: PubMed

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