Magnifying Narrow-Band Imaging Endoscopy For Diagnosis Of Helicobacter Pylori Infection And Chronic Gastritis Related Study

Background and Study Aims:Infection with helicobacter pylori(H. pylori) is a worldwide problem.The incidence of H. pylori infection in our country is high. Unlike the case in Western countries, H. pylori infection is now well accepted as a predisposing factor for development of peptic ulcer disease and gastric cancer. Although H. pylori-infected gastric mucosa is characterized as acute or chronic inflammation, atrophy and intestinal metaplasia, there is a marked variation in the degree and extension of gastric inflammation and atrophy in H. pylori infected individuals. This difference is especially important to predict an individual’s risk for developing gastric diseases.However, by using conventional white light endoscopy, precise diagnosis of gastric inflammation and atrophy is difficult without multiple biopsies.The narrow-band imaging(NBI) system is an endoscopic imaging technique for the enhanced visualization of mucosal microscopic structure and capillaries of the superficial mucosal layer. Images are obtained by using narrower bands of red, blue, and green filters, which are different from conventional red-green-blue filters. Combining the NBI system and magnifying endoscopy allows simple and clear visualization of microscopic structures of the superficial mucosa and itscapillary patterns, which may be useful for precise endoscopic diagnosis,being more closely to histopathological diagnosis. H. pylori-induced gastritis is characterized by a number of specific endoscopic findings. In the non-neoplastic gastric mucosa, there have been reports showing a potential usefulness of magnifying NBI for the diagnosis of H. pylori infection, histological gastritis. This report is to investigate gastric mucosal patterns by using magnifying NBI endoscopy and identify any relationship between those patterns and H. pylori–induced gastritis and specific histological features。Patients and Methods:A total of 87 patients were included from October 2015 to March2016 at the first hospital of Jilin university according to inclusion criteria.The whole stomach was examined first with conventional endoscopy,followed by Magnifying narrow-band imaging observation of the pits,subepithelial capillary networks and collecting venules of gastric body.All endoscopies were performed by endoscopists who were experienced in Magnifying narrow-band imaging of the upper gastrointestinal tract.For amplification site, pathologic histological test including inflammatory classification, activity, atrophic diagnosis was conducted. Rapid urease test at antrum of stomach and14 C breath test were conducted to judge the infection of H. pylori. At last, Magnifying Narrow-Band ImagingEndoscopy for diagnosis of H. pylori infection and chronic gastritis were analyzed.Results:28 patients were diagnosed as having H. pylori-negative normal stomach and 59 as having H. pylori-positive gastritis. The Magnifying narrow-band imaging views were classified into four types: Z-0: small,round pits surrounded by regular subepithelial capillary networks(SECNs), which are regularly interspersed with collecting venules(type Z-0;n=25); ii)slightly enlarged,round pit with unclear or irregular SECNs.(type Z-1; n = 21); iii)obviously enlarged, oval or prolonged pit with increased density of irregular vessels.(Z-2;n=27); and iv)well-demarcated, oval or tubulovillous pit with clearly visible coiled or wavy vessels.(Z-3; n=14). Most of the cases of H. pylori negative normal stomach were type Z-0, whereas H. pylori-induced gastritis was present in all cases where the classification was Z-1, Z-2, or Z-3. Type Z-0differed significantly from types Z-1, Z-2, and Z-3 with regard to the grade of inflammation, activity, and presence of H. pylori. Type Z-3differed significantly from types Z-0, Z-1, and Z-2 with regard to the atrophy.Conclusions:1. Small, round pits surrounded by regular subepithelial capillary networks(SECNs), which are regularly interspersed with collectingvenules(type Z-0) were observed in the H. pylori-negative normal mucosa. The views of H. pylori-related gastritis were more in type Z-1,Z-2, Z-3.2.Type Z-0 differed significantly from types Z-1, Z-2, and Z-3 with regard to the grade of inflammation, activity, and presence of H. pylori.Type Z-3 differed significantly from types Z-0, Z-1, and Z-2 with regard to the atrophy.3. Magnifying narrow-band Imaging Endoscopy for diagnosis of H.pylori infection and chronic gastritis has a certain value. It provides a new method of the diagnosis of H. pylori infection and gastric mucosa pathological state, improving the consistent rate of endoscopic and pathology diagnosis.