Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infecti...Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infection and evaluate gastric cancer risk.In 2013,the Japan Gastroenterological Endoscopy Society advocated the Kyoto classification,a new grading system for endoscopic gastritis.The Kyoto classification organized endoscopic findings related to H.pylori infection.The Kyoto classification score is the sum of scores for five endoscopic findings(atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness with or without regular arrangement of collecting venules)and ranges from 0 to 8.Atrophy,intestinal metaplasia,enlarged folds,and nodularity contribute to gastric cancer risk.Diffuse redness and regular arrangement of collecting venules are related to H.pylori infection status.In subjects without a history of H.pylori eradication,the infection rates in those with Kyoto scores of 0,1,and≥2 were 1.5%,45%,and 82%,respectively.A Kyoto classification score of 0 indicates no H.pylori infection.A Kyoto classification score of 2 or more indicates H.pylori infection.Kyoto classification scores of patients with and without gastric cancer were 4.8 and 3.8,respectively.A Kyoto classification score of 4 or more might indicate gastric cancer risk.展开更多
BACKGROUND Endoscopy-based Kyoto classification for gastritis and pathological topographic distribution of neutrophil infiltration are correlated with gastric cancer risk.AIM To investigate the association between Kyo...BACKGROUND Endoscopy-based Kyoto classification for gastritis and pathological topographic distribution of neutrophil infiltration are correlated with gastric cancer risk.AIM To investigate the association between Kyoto classification and the topographic distribution of neutrophil activity.METHODS Kyoto classification score,ranging from 0 to 8,consisted of atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Neutrophil activity was scored according to the updated Sydney System using biopsy samples obtained from the greater curvature of the corpus and the antrum.The participants were divided into four categories,inactive stomach,antrumpredominant gastritis,pangastritis,and corpus-predominant gastritis,based on the topographic distribution of neutrophil activity.Effects of sex,age,body mass index,drinking habit,smoking habit,family history of gastric cancer,serum Helicobacter pylori(H.pylori)antibody,and Kyoto score on topography of neutrophil infiltration were analyzed.RESULTS A total of 327 patients(comprising 50.7%women,with an average age of 50.2 years)were enrolled in this study.H.pylori infection rate was 82.9%with a mean Kyoto score of 4.63.The Kyoto score was associated with the topographic distribution of neutrophil activity.Kyoto scores were significantly higher in the order of inactive stomach,antrum-predominant gastritis,pangastritis,and corpuspredominant gastritis(3.05,4.57,5.21,and 5.96,respectively).Each individual score of endoscopic findings(i.e.,atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness)was correlated with the topographic distribution of neutrophil activity.On multivariate analysis,the Kyoto score,age,and serum H.pylori antibody were independently associated with the topographic distribution of neutrophil activity.CONCLUSION The Kyoto classification score was associated with the topographic distribution of neutrophil activity.展开更多
BACKGROUND Gastric cancer(GC)incidence based on the endoscopic Kyoto classification of gastritis has not been systematically investigated using time-to-event analysis.AIM To examine GC incidence in an endoscopic surve...BACKGROUND Gastric cancer(GC)incidence based on the endoscopic Kyoto classification of gastritis has not been systematically investigated using time-to-event analysis.AIM To examine GC incidence in an endoscopic surveillance cohort.METHODS This study was retrospectively conducted at the Toyoshima Endoscopy Clinic.Patients who underwent two or more esophagogastroduodenoscopies were enrolled.GC incidence was based on Kyoto classification scores,such as atrophy,intestinal metaplasia(IM),enlarged folds(EFs),nodularity,diffuse redness(DR),and total Kyoto scores.Hazard ratios(HRs)adjusted for age and sex were calculated using a Cox hazard model.RESULTS A total of 6718 patients were enrolled(median age 54.0 years;men 44.2%).During the follow-up period(max 5.02 years;median 2.56 years),GC developed in 34 patients.The average frequency of GCs per year was 0.19%.Kyoto atrophy scores 1[HR with score 0 as reference:3.66,95%confidence interval(CI):1.06 to 12.61],2(11.60,3.82-35.27),IM score 2(9.92,4.37-22.54),EF score 1(4.03,1.63-9.96),DR scores 1(6.22,2.65-14.56),and 2(10.01,3.73-26.86)were associated with GC incidence,whereas nodularity scores were not.The total Kyoto scores of 4(HR with total Kyoto scores 0-1 as reference:6.23,95%CI:1.93 to 20.13,P=0.002)and 5-8(16.45,6.29-43.03,P<0.001)were more likely to develop GC,whereas the total Kyoto scores 2-3 were not.The HR of the total Kyoto score for developing GC per 1 rank was 1.75(95%CI:1.46 to 2.09,P<0.001).CONCLUSION A high total Kyoto score(≥4)was associated with GC incidence.The endoscopy-based diagnosis of gastritis can stratify GC risk.展开更多
This editorial provides an update of the recent evidence on the endoscopy-based Kyoto classification of gastritis,clarifying the shortcomings of the Kyoto classification,and providing prospects for future research,wit...This editorial provides an update of the recent evidence on the endoscopy-based Kyoto classification of gastritis,clarifying the shortcomings of the Kyoto classification,and providing prospects for future research,with particular focus on the histological subtypes of gastric cancer(GC)and Helicobacter pylori(H.pylori)infection status.The total Kyoto score is designed to express GC risk on a score ranging from 0 to 8,based on the following five endoscopic findings:Atrophy,intestinal metaplasia(IM),enlarged folds(EF),nodularity,and diffuse redness(DR).The total Kyoto score reflects H.pylori status as follows:0,≥2,and≥4 indicate a normal stomach,H.pylori-infected gastritis,and gastritis at risk for GC,respectively.Regular arrangement of collecting venules(RAC)predicts noninfection;EF,nodularity,and DR predict current infection;map-like redness(MLR)predicts past infection;and atrophy and IM predict current or past infection.Atrophy,IM,and EF all increase the incidence of H.pylori-infected GC.MLR is a specific risk factor for H.pylori-eradicated GC,while RAC results in less GC.Diffuse-type GC can be induced by active inflammation,which presents as EF,nodularity,and atrophy on endoscopy,as well as neutrophil and mononuclear cell infiltration on histology.In contrast,intestinal-type GC develops via atrophy and IM,and is consistent between endoscopy and histology.However,this GC risk-scoring design needs to be improved.展开更多
BACKGROUND Endoscopic Kyoto classification predicts gastric cancer risk;however,the score in the patients with primary gastric cancer after Helicobacter pylori(H.pylori)eradication therapy is unknown.AIM To elucidate ...BACKGROUND Endoscopic Kyoto classification predicts gastric cancer risk;however,the score in the patients with primary gastric cancer after Helicobacter pylori(H.pylori)eradication therapy is unknown.AIM To elucidate the Kyoto classification score in patients with both single gastric cancer and multiple gastric cancers developed after H.pylori eradication.METHODS The endoscopist recorded the Kyoto classification at the endoscope and the Kyoto classification score at the time of the first diagnosis of gastric cancer after H.pylori eradication.The score was compared between single gastric cancer group and multiple gastric cancers group.RESULTS The Kyoto score at the time of diagnosis of 45 cases of gastric cancer after H.pylori eradication was 4.0 points in average.The score was 3.8 points in the single gastric cancer group,and 5.1 points in the multiple gastric cancers group.The multiple group had a significantly higher score than the single group(P=0.016).In the multiple gastric cancers group,all the patients(7/7)had 5 or higher Kyoto score,while in single gastric cancer group,the proportion of patients with a score of 5 or higher was less than half,or 44.7%(17/38).CONCLUSION Patients diagnosed with gastric cancer after H.pylori eradication tended to have advanced gastritis.In particular,in cases of multiple gastric cancers developed after H.pylori eradication,the endoscopic Kyoto classification score tended to be 5 or higher in patients with an open type atrophic gastritis and the intestinal metaplasia extended to the corpus.展开更多
BACKGROUND Gastric cancers can be categorized into diffuse-and intestinal-type cancers based on the Lauren histopathological classification.These two subtypes show distinct differences in metastasis frequency,treatmen...BACKGROUND Gastric cancers can be categorized into diffuse-and intestinal-type cancers based on the Lauren histopathological classification.These two subtypes show distinct differences in metastasis frequency,treatment application,and prognosis.Therefore,accurately assessing the Lauren classification before treatment is crucial.However,studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved.AIM To investigate patient characteristics including endoscopic gastritis associated with diffuse-and intestinal-type gastric cancers in Helicobacter pylori(H.pylori)-infected patients.METHODS Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.The effects of age,sex,and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed.We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification.Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined.RESULTS A total of 499 H.pylori-infected patients(49.6%males;average age:54.9 years)were enrolled;132 patients with gastric cancer(39 diffuse-and 93 intestinal-type cancers)and 367 cancer-free controls were eligible.Gastric cancer was independently associated with age≥65 years,high atrophy score,high intestinal metaplasia score,and low nodularity score when compared to the control.Factors independently associated with intestinal-type cancer were age≥65 years(coefficient:1.98),male sex(coefficient:1.02),high intestinal metaplasia score(coefficient:0.68),and low enlarged folds score(coefficient:-1.31)when compared to diffuse-type cancer.The Lauren predictive background score was defined as the sum of+2(age≥65 years),+1(male sex),+1(endoscopic intestinal metaplasia),and-1(endoscopic enlarged folds)points.Area under the receiver operative characteristic curve of the Lauren predictive background score was 0.828 for predicting intestinal-type cancer.With a cut-off value of+2,the sensitivity,specificity,and accuracy of the Lauren predictive background score were 81.7%,71.8%,and 78.8%,respectively.CONCLUSION Patient backgrounds,such as age,sex,endoscopic intestinal metaplasia,and endoscopic enlarged folds are useful for predicting the Lauren type of gastric cancer.展开更多
Chronic gastritis(CG)is a widespread and frequent disease,mainly caused by Helicobacter pylori infection,which is associated with an increased risk of gastric cancer.Virtual chromoendoscopy improves the endoscopic dia...Chronic gastritis(CG)is a widespread and frequent disease,mainly caused by Helicobacter pylori infection,which is associated with an increased risk of gastric cancer.Virtual chromoendoscopy improves the endoscopic diagnostic efficacy,which is essential to establish the most appropriate therapy and to enable cancer prevention.Artificial intelligence provides algorithms for the diagnosis of gastritis and,in particular,early gastric cancer,but it is not yet used in practice.Thus,technological innovation,through image resolution and processing,optimizes the diagnosis and management of CG and gastric cancer.The endoscopic Kyoto classification of gastritis improves the diagnosis and management of this disease,but through the analysis of the most recent literature,new algorithms can be proposed.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection is closely related to the development of gastric cancer(GC).However,GC can develop even after H.pylori eradication.Therefore,it would be extremely useful if GC could b...BACKGROUND Helicobacter pylori(H.pylori)infection is closely related to the development of gastric cancer(GC).However,GC can develop even after H.pylori eradication.Therefore,it would be extremely useful if GC could be predicted after eradication.The Kyoto classification score for gastritis(GA)is closely related to cancer risk.However,how the score for GC changes after eradication before onset is not well understood.AIM To investigate the characteristics of the progression of Kyoto classification scores for GC after H.pylori eradication.METHODS Eradication of H.pylori was confirmed in all patients using either the urea breath test or the stool antigen test.The Kyoto classification score of GC patients was evaluated by endoscopy at the time of event onset and three years earlier.In ad-dition,the modified atrophy score was evaluated and compared between the GC group and the control GA group.RESULTS In total,30 cases of early GC and 30 cases of chronic GA were evaluated.The pathology of the cancer cases was differentiated adenocarcinoma,except for one case of undifferentiated adenocarcinoma.The total score of the Kyoto classifi-cation was significantly higher in the GC group both at the time of cancer onset and three years earlier(4.97 vs 3.73,P=0.0034;4.2 vs 3.1,P=0.0035,respectively).The modified atrophy score was significantly higher in the GC group both at the time of cancer onset and three years earlier and was significantly improved only in the GA group(5.3 vs 5.3,P=0.5;3.73 vs 3.1,P=0.0475,respectively).CONCLUSION The course of the modified atrophy score is useful for predicting the onset of GC after eradication.Patients with severe atrophy after H.pylori eradication require careful monitoring.展开更多
BACKGROUND Accurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice.The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins;h...BACKGROUND Accurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice.The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins;however,evaluating invasion depth based on endoscopic background gastritis remains unclear.AIM To investigate predicting submucosal invasion using the endoscopy-based Kyoto classification of gastritis.METHODS Patients with gastric cancer detected on esophagogastroduodenoscopy at Toyoshima Endoscopy Clinic were enrolled.We analyzed the effects of patient and tumor characteristics,including age,sex,body mass index,surveillance endoscopy within 2 years,current Helicobacter pylori infection,the Kyoto classification,and Lauren’s tumor type,on submucosal tumor invasion and curative endoscopic resection.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Atrophy was characterized by non-reddish and low mucosa.Intestinal metaplasia was detected as patchy whitish or grayish-white flat elevations,forming an irregular uneven surface.An enlarged fold referred to a fold width≥5 mm in the greater curvature of the corpus.Nodularity was characterized by goosebump-like multiple nodules in the antrum.Diffuse redness was characterized by uniform reddish nonatrophic mucosa in the greater curvature of the corpus.RESULTS A total of 266 gastric cancer patients(mean age,66.7 years;male sex,58.6%;mean body mass index,22.8 kg/m2)were enrolled.Ninety-three patients underwent esophagogastroduodenoscopy for surveillance within 2 years,and 140 had current Helicobacter pylori infection.The mean Kyoto score was 4.54.Fifty-eight cancers were diffuse-type,and 87 cancers had invaded the submucosa.Multivariate analysis revealed that low body mass index(odds ratio 0.88,P=0.02),no surveillance esophagogastroduodenoscopy within 2 years(odds ratio 0.15,P<0.001),endoscopic enlarged folds of gastritis(odds ratio 3.39,P=0.001),and Lauren’s diffuse-type(odds ratio 5.09,P<0.001)were independently associated with submucosal invasion.Similar results were obtained with curative endoscopic resection.Among cancer patients with enlarged folds,severely enlarged folds(width≥10 mm)were more related to submucosal invasion than mildly enlarged folds(width 5-9 mm,P<0.001).CONCLUSION Enlarged folds of gastritis were associated with submucosal invasion.Endoscopic observation of background gastritis as well as the lesion itself may help diagnose the depth of cancer invasion.展开更多
文摘Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infection and evaluate gastric cancer risk.In 2013,the Japan Gastroenterological Endoscopy Society advocated the Kyoto classification,a new grading system for endoscopic gastritis.The Kyoto classification organized endoscopic findings related to H.pylori infection.The Kyoto classification score is the sum of scores for five endoscopic findings(atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness with or without regular arrangement of collecting venules)and ranges from 0 to 8.Atrophy,intestinal metaplasia,enlarged folds,and nodularity contribute to gastric cancer risk.Diffuse redness and regular arrangement of collecting venules are related to H.pylori infection status.In subjects without a history of H.pylori eradication,the infection rates in those with Kyoto scores of 0,1,and≥2 were 1.5%,45%,and 82%,respectively.A Kyoto classification score of 0 indicates no H.pylori infection.A Kyoto classification score of 2 or more indicates H.pylori infection.Kyoto classification scores of patients with and without gastric cancer were 4.8 and 3.8,respectively.A Kyoto classification score of 4 or more might indicate gastric cancer risk.
基金Ministry of Education,Culture,Sports,Science and Technology of Japan,No.25134707 and No.16H01566(to Matsuda K),and No.15K14377(to Tanikawa C)funding from the Tailor-Made Medical Treatment with the BBJ Project from Japan Agency for Medical Research and Development,AMED(from April 2015)and the Ministry of Education,Culture,Sports,Science,and Technology of Japan(from April 2003 to March 2015).
文摘BACKGROUND Endoscopy-based Kyoto classification for gastritis and pathological topographic distribution of neutrophil infiltration are correlated with gastric cancer risk.AIM To investigate the association between Kyoto classification and the topographic distribution of neutrophil activity.METHODS Kyoto classification score,ranging from 0 to 8,consisted of atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Neutrophil activity was scored according to the updated Sydney System using biopsy samples obtained from the greater curvature of the corpus and the antrum.The participants were divided into four categories,inactive stomach,antrumpredominant gastritis,pangastritis,and corpus-predominant gastritis,based on the topographic distribution of neutrophil activity.Effects of sex,age,body mass index,drinking habit,smoking habit,family history of gastric cancer,serum Helicobacter pylori(H.pylori)antibody,and Kyoto score on topography of neutrophil infiltration were analyzed.RESULTS A total of 327 patients(comprising 50.7%women,with an average age of 50.2 years)were enrolled in this study.H.pylori infection rate was 82.9%with a mean Kyoto score of 4.63.The Kyoto score was associated with the topographic distribution of neutrophil activity.Kyoto scores were significantly higher in the order of inactive stomach,antrum-predominant gastritis,pangastritis,and corpuspredominant gastritis(3.05,4.57,5.21,and 5.96,respectively).Each individual score of endoscopic findings(i.e.,atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness)was correlated with the topographic distribution of neutrophil activity.On multivariate analysis,the Kyoto score,age,and serum H.pylori antibody were independently associated with the topographic distribution of neutrophil activity.CONCLUSION The Kyoto classification score was associated with the topographic distribution of neutrophil activity.
文摘BACKGROUND Gastric cancer(GC)incidence based on the endoscopic Kyoto classification of gastritis has not been systematically investigated using time-to-event analysis.AIM To examine GC incidence in an endoscopic surveillance cohort.METHODS This study was retrospectively conducted at the Toyoshima Endoscopy Clinic.Patients who underwent two or more esophagogastroduodenoscopies were enrolled.GC incidence was based on Kyoto classification scores,such as atrophy,intestinal metaplasia(IM),enlarged folds(EFs),nodularity,diffuse redness(DR),and total Kyoto scores.Hazard ratios(HRs)adjusted for age and sex were calculated using a Cox hazard model.RESULTS A total of 6718 patients were enrolled(median age 54.0 years;men 44.2%).During the follow-up period(max 5.02 years;median 2.56 years),GC developed in 34 patients.The average frequency of GCs per year was 0.19%.Kyoto atrophy scores 1[HR with score 0 as reference:3.66,95%confidence interval(CI):1.06 to 12.61],2(11.60,3.82-35.27),IM score 2(9.92,4.37-22.54),EF score 1(4.03,1.63-9.96),DR scores 1(6.22,2.65-14.56),and 2(10.01,3.73-26.86)were associated with GC incidence,whereas nodularity scores were not.The total Kyoto scores of 4(HR with total Kyoto scores 0-1 as reference:6.23,95%CI:1.93 to 20.13,P=0.002)and 5-8(16.45,6.29-43.03,P<0.001)were more likely to develop GC,whereas the total Kyoto scores 2-3 were not.The HR of the total Kyoto score for developing GC per 1 rank was 1.75(95%CI:1.46 to 2.09,P<0.001).CONCLUSION A high total Kyoto score(≥4)was associated with GC incidence.The endoscopy-based diagnosis of gastritis can stratify GC risk.
文摘This editorial provides an update of the recent evidence on the endoscopy-based Kyoto classification of gastritis,clarifying the shortcomings of the Kyoto classification,and providing prospects for future research,with particular focus on the histological subtypes of gastric cancer(GC)and Helicobacter pylori(H.pylori)infection status.The total Kyoto score is designed to express GC risk on a score ranging from 0 to 8,based on the following five endoscopic findings:Atrophy,intestinal metaplasia(IM),enlarged folds(EF),nodularity,and diffuse redness(DR).The total Kyoto score reflects H.pylori status as follows:0,≥2,and≥4 indicate a normal stomach,H.pylori-infected gastritis,and gastritis at risk for GC,respectively.Regular arrangement of collecting venules(RAC)predicts noninfection;EF,nodularity,and DR predict current infection;map-like redness(MLR)predicts past infection;and atrophy and IM predict current or past infection.Atrophy,IM,and EF all increase the incidence of H.pylori-infected GC.MLR is a specific risk factor for H.pylori-eradicated GC,while RAC results in less GC.Diffuse-type GC can be induced by active inflammation,which presents as EF,nodularity,and atrophy on endoscopy,as well as neutrophil and mononuclear cell infiltration on histology.In contrast,intestinal-type GC develops via atrophy and IM,and is consistent between endoscopy and histology.However,this GC risk-scoring design needs to be improved.
文摘BACKGROUND Endoscopic Kyoto classification predicts gastric cancer risk;however,the score in the patients with primary gastric cancer after Helicobacter pylori(H.pylori)eradication therapy is unknown.AIM To elucidate the Kyoto classification score in patients with both single gastric cancer and multiple gastric cancers developed after H.pylori eradication.METHODS The endoscopist recorded the Kyoto classification at the endoscope and the Kyoto classification score at the time of the first diagnosis of gastric cancer after H.pylori eradication.The score was compared between single gastric cancer group and multiple gastric cancers group.RESULTS The Kyoto score at the time of diagnosis of 45 cases of gastric cancer after H.pylori eradication was 4.0 points in average.The score was 3.8 points in the single gastric cancer group,and 5.1 points in the multiple gastric cancers group.The multiple group had a significantly higher score than the single group(P=0.016).In the multiple gastric cancers group,all the patients(7/7)had 5 or higher Kyoto score,while in single gastric cancer group,the proportion of patients with a score of 5 or higher was less than half,or 44.7%(17/38).CONCLUSION Patients diagnosed with gastric cancer after H.pylori eradication tended to have advanced gastritis.In particular,in cases of multiple gastric cancers developed after H.pylori eradication,the endoscopic Kyoto classification score tended to be 5 or higher in patients with an open type atrophic gastritis and the intestinal metaplasia extended to the corpus.
文摘BACKGROUND Gastric cancers can be categorized into diffuse-and intestinal-type cancers based on the Lauren histopathological classification.These two subtypes show distinct differences in metastasis frequency,treatment application,and prognosis.Therefore,accurately assessing the Lauren classification before treatment is crucial.However,studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved.AIM To investigate patient characteristics including endoscopic gastritis associated with diffuse-and intestinal-type gastric cancers in Helicobacter pylori(H.pylori)-infected patients.METHODS Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.The effects of age,sex,and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed.We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification.Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined.RESULTS A total of 499 H.pylori-infected patients(49.6%males;average age:54.9 years)were enrolled;132 patients with gastric cancer(39 diffuse-and 93 intestinal-type cancers)and 367 cancer-free controls were eligible.Gastric cancer was independently associated with age≥65 years,high atrophy score,high intestinal metaplasia score,and low nodularity score when compared to the control.Factors independently associated with intestinal-type cancer were age≥65 years(coefficient:1.98),male sex(coefficient:1.02),high intestinal metaplasia score(coefficient:0.68),and low enlarged folds score(coefficient:-1.31)when compared to diffuse-type cancer.The Lauren predictive background score was defined as the sum of+2(age≥65 years),+1(male sex),+1(endoscopic intestinal metaplasia),and-1(endoscopic enlarged folds)points.Area under the receiver operative characteristic curve of the Lauren predictive background score was 0.828 for predicting intestinal-type cancer.With a cut-off value of+2,the sensitivity,specificity,and accuracy of the Lauren predictive background score were 81.7%,71.8%,and 78.8%,respectively.CONCLUSION Patient backgrounds,such as age,sex,endoscopic intestinal metaplasia,and endoscopic enlarged folds are useful for predicting the Lauren type of gastric cancer.
文摘Chronic gastritis(CG)is a widespread and frequent disease,mainly caused by Helicobacter pylori infection,which is associated with an increased risk of gastric cancer.Virtual chromoendoscopy improves the endoscopic diagnostic efficacy,which is essential to establish the most appropriate therapy and to enable cancer prevention.Artificial intelligence provides algorithms for the diagnosis of gastritis and,in particular,early gastric cancer,but it is not yet used in practice.Thus,technological innovation,through image resolution and processing,optimizes the diagnosis and management of CG and gastric cancer.The endoscopic Kyoto classification of gastritis improves the diagnosis and management of this disease,but through the analysis of the most recent literature,new algorithms can be proposed.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is closely related to the development of gastric cancer(GC).However,GC can develop even after H.pylori eradication.Therefore,it would be extremely useful if GC could be predicted after eradication.The Kyoto classification score for gastritis(GA)is closely related to cancer risk.However,how the score for GC changes after eradication before onset is not well understood.AIM To investigate the characteristics of the progression of Kyoto classification scores for GC after H.pylori eradication.METHODS Eradication of H.pylori was confirmed in all patients using either the urea breath test or the stool antigen test.The Kyoto classification score of GC patients was evaluated by endoscopy at the time of event onset and three years earlier.In ad-dition,the modified atrophy score was evaluated and compared between the GC group and the control GA group.RESULTS In total,30 cases of early GC and 30 cases of chronic GA were evaluated.The pathology of the cancer cases was differentiated adenocarcinoma,except for one case of undifferentiated adenocarcinoma.The total score of the Kyoto classifi-cation was significantly higher in the GC group both at the time of cancer onset and three years earlier(4.97 vs 3.73,P=0.0034;4.2 vs 3.1,P=0.0035,respectively).The modified atrophy score was significantly higher in the GC group both at the time of cancer onset and three years earlier and was significantly improved only in the GA group(5.3 vs 5.3,P=0.5;3.73 vs 3.1,P=0.0475,respectively).CONCLUSION The course of the modified atrophy score is useful for predicting the onset of GC after eradication.Patients with severe atrophy after H.pylori eradication require careful monitoring.
文摘BACKGROUND Accurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice.The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins;however,evaluating invasion depth based on endoscopic background gastritis remains unclear.AIM To investigate predicting submucosal invasion using the endoscopy-based Kyoto classification of gastritis.METHODS Patients with gastric cancer detected on esophagogastroduodenoscopy at Toyoshima Endoscopy Clinic were enrolled.We analyzed the effects of patient and tumor characteristics,including age,sex,body mass index,surveillance endoscopy within 2 years,current Helicobacter pylori infection,the Kyoto classification,and Lauren’s tumor type,on submucosal tumor invasion and curative endoscopic resection.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Atrophy was characterized by non-reddish and low mucosa.Intestinal metaplasia was detected as patchy whitish or grayish-white flat elevations,forming an irregular uneven surface.An enlarged fold referred to a fold width≥5 mm in the greater curvature of the corpus.Nodularity was characterized by goosebump-like multiple nodules in the antrum.Diffuse redness was characterized by uniform reddish nonatrophic mucosa in the greater curvature of the corpus.RESULTS A total of 266 gastric cancer patients(mean age,66.7 years;male sex,58.6%;mean body mass index,22.8 kg/m2)were enrolled.Ninety-three patients underwent esophagogastroduodenoscopy for surveillance within 2 years,and 140 had current Helicobacter pylori infection.The mean Kyoto score was 4.54.Fifty-eight cancers were diffuse-type,and 87 cancers had invaded the submucosa.Multivariate analysis revealed that low body mass index(odds ratio 0.88,P=0.02),no surveillance esophagogastroduodenoscopy within 2 years(odds ratio 0.15,P<0.001),endoscopic enlarged folds of gastritis(odds ratio 3.39,P=0.001),and Lauren’s diffuse-type(odds ratio 5.09,P<0.001)were independently associated with submucosal invasion.Similar results were obtained with curative endoscopic resection.Among cancer patients with enlarged folds,severely enlarged folds(width≥10 mm)were more related to submucosal invasion than mildly enlarged folds(width 5-9 mm,P<0.001).CONCLUSION Enlarged folds of gastritis were associated with submucosal invasion.Endoscopic observation of background gastritis as well as the lesion itself may help diagnose the depth of cancer invasion.
