Endoscopic and histological features of gastric cancers after successful Helicobacter pylori eradication therapy.
BACKGROUND
Gastric cancer after successful Helicobacter pylori eradication therapy is often difficult to diagnose by endoscopy because of its indistinct borderline or lack of obviously cancerous characteristics. Furthermore, it has become evident that non-neoplastic epithelium covers cancerous areas in gastric cancer after eradication. Here, we investigated these endoscopic features and their relationship to histological findings.


METHODS
We studied 24 and 47 gastric cancers in patients who had (eradication group) and had not (control group) undergone H. pylori eradication, respectively. A gastritis-like appearance revealed by conventional endoscopy was defined as a mucosal pattern with no marked difference from the surrounding non-cancerous area and that revealed by narrow-band imaging (NBI)-magnifying endoscopy (ME) as the mucosal pattern observed in H. pylori-associated atrophic gastritis. We investigated a gastritis-like appearance revealed by conventional endoscopy (A), a gastritis-like appearance at the margin (B) and within (C) the cancerous area revealed by NBI-ME, and the histological characteristics of the overlying non-neoplastic epithelium. We also evaluated the relationship between endoscopic and histological findings in the eradication group.


RESULTS
Endoscopy showed that features A, B and C were significantly more frequent in the eradication group (P = 0.031, P < 0.001, P < 0.001, respectively). Non-neoplastic epithelium covered more than 10 % of the cancerous area more frequently in the eradication group. In the eradication group, more than 90 % of cancers showing a gastritis-like appearance had non-neoplastic epithelium extending over 10 % of the cancerous area.


CONCLUSIONS
Gastric cancer after successful H. pylori eradication tends to have gastritis-like features due to non-neoplastic epithelium covering the cancerous tissue.
Department of Gastroenterology, Niigata Prefectural Yoshida Hospital, 32-14 Daibo-cho, Yoshida, Tsubame, Niigata, 959-0242, Japan.
Akiko
A
Saka
Department of Gastroenterology, Niigata Prefectural Yoshida Hospital, 32-14 Daibo-cho, Yoshida, Tsubame, Niigata, 959-0242, Japan. yagikazu@pop12.odn.ne.jp.
Kazuyoshi
K
Yagi
Department of Pathology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jyonan-ku, Fukuoka, 814-0180, Japan.
Satoshi
S
Nimura
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003113:Colonoscopy / Q000379:methods; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005773:Gastroscopy / Q000379:methods; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology*
Eradication therapy; Gastric cancer; H. pylori; Magnifying endoscopy; Narrow-band imaging