Correlation Of Magnifying Endoscopic Patterns And Histopathology Of The Gastric Mucosa

Background and Aims Recently, magnifying endoscope has been used clinically for its developments in amplifying power, definition and operational capability. Lots of international studies on clinical application of magnifying endoscope especially from Japan have been reported, but most of them were focused on colon and esophagus, only a few of them on gastric mucosa have been published. In this article, we reported our study on correlation of magnifying endoscopic patterns and histopathology, Helicobacter pylori (Hp) infection of the gastric mucosa in 140 patients with chronic gastritis to understand the value of magnifying endoscopy in diagnosing the minute lesions of gastric mucosa.Materials and Methods Gastric mucosal patterns in 140 patients with chronic gastritis were studied using Olympus GIF-Q240Z magnifying endoscope. Histopathological examination,including mucin histochemistry and PCNA immunohistochemistry and Hp detection,including rapid urease test and Warthin-Starry staining were taken with biopsy samples from the magnified sites of stomach. The magnifying endoscopic patterns were compared with histopathological results and Hp detection. Results The pit patterns of gastric mucosa were classified as follows: types A (round spot), B (short rod), C (branched), D (reticular) and E (villus). The detection rate of chronic atrophic gastritis by magnifying endoscopy was 94.3%(33/35), which was significantly higher than that by routine endoscopy (22.9%, 8/35)(P<0.01). The pit patterns of 31 cases with intestinal metaplasia (IM) appeared as type E in 18 cases (58.1%), type D in 8 cases (25.8%) and type C in 5 cases (16.1%). Fourteen of 18 cases (77.8%) with complete type of IM appeared as type E of pit patterns , whereas only 4 of 13 (30.8%)cases with incomplete type of IM appeared as the type E (P<0.05).Collecting venules in the anterior of lower part of gastric corpus were subgrouped into: type R(regular), I(irregular) and D(disappeared). Hp infection were found in 12.2%(9/74), 60%(9/15) and 84.3%(43/51) cases in these types respectively. Hp infection rate in type R was significantly lower than that of other two types (P<0.01). The percentage of PCNA-labeling proliferation index was found in type E (14.67±5.56) and type D (13.40±4.88) of gastric pits, which was significantly higher than that intype A (6.96±2.35) (P<0.05).Conclusion ①The classification of gastric pits by magnifying endoscopy reflects not only morphological features but also histological features. Type A and type B represent the normal pits of corpus and antrum respectively.The other three appear in abnormal mucosa, among them Type E only appears in the mucosa with IM. ②The architecture of collecting venules is closely related to Hp infection. Most mucosa without Hp infection have regular spider-like and jellyfish-like arrangement of collecting venules (type R).Whereas the mucosa with Hp infection appeared as irregular arrangement (type I) or disappearance (type D) of collecting venules.③ Under magnifying endoscopy, disordered structures, deficiency and even disappearance of gastric pits are of high detection rate and accuracy for atrophic gastritis.④Different types of gastric pits have difference not only in histological features but also in capability of mucus secretion and proliferation. Type E may be a characteristic appearance of the mucosa with complete IM. And pits of type D and type E may have higher activity of cell proliferation.