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Image-enhanced endoscopy for real-time differentiation between hyperplastic and fundic gland polyps in the stomach

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Abstract

Background

Fundic gland polyps (FGP) of stomach are benign, while some hyperplastic polyps (HP) may harbor dysplasia or malignancy. Conventional white light endoscopy (WLE) cannot reliably distinguish FGP from HP. We investigated the role of image-enhanced endoscopy in differentiating FGP from HP.

Methods

Patients with gastric polyps were recruited prospectively. The characteristics of the polyps were assessed using WLE and magnification narrow band imaging (mNBI). The microsurface, intervening space (IS), and microvascular (V) features of polyps were evaluated on mNBI. The pattern characteristic of FGP and HP were determined. Histopathology of polyps was the gold standard for diagnosis. Finally, in the validation phase, five endoscopists applied the characteristic features identified in this study to predict the type of gastric polyp and their performance was assessed.

Results

Forty-five patients with a total of 70 gastric polyps (HP—46, FGP—24) were included in this study. On mNBI, the pattern characteristic of HP included peripheral curved type of white structures forming large circular/villous loops (microsurface), enlarged intervening space, and microvessels appearing as dark patches in the intervening space (p<0.001 vs. FGP). These were noted in 95.7% HP. In contrast, 95.8% FGP had a pattern characterized by dotted/elliptical/tubular white structures (microsurface), normal width of intervening space, and microvessels surrounding the white structures in a network pattern. This IS-V pattern classification had an accuracy of >90% in the validation phase with intra-class correlation coefficient of 0.95. The accuracy of mNBI was higher than WLE (97.1% vs. 67%) in predicting the type of gastric polyp.

Conclusions

Image-enhanced endoscopy with mNBI (IS-V pattern) performs very well in differentiating HP from FGP.

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Acknowledgements

We acknowledge the help and support offered by the following people in the conduct of this study—Dr. Anoop John, Dr. Lalji Patel, Dr. Ajith Thomas, Dr. Rajeeva S A, and all the staff of Endoscopy Unit, Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, India.

Funding

The study was funded by internal grant (FLUID grant) provided by the parent institute (IRB No. 10031 dated 04.04.2016, Christian Medical College Vellore, India).

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Authors and Affiliations

  1. Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, 632 004, India

    Amit Kumar Dutta, Deepu David, Rajeeb Jaleel, Reuben T. Kurien, Sudipta D. Chowdhury, Ebby G. Simon, Anjilivelil J. Joseph & Anna B. Pulimood

  2. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

    Noriya Uedo

  3. Department of Pathology, Velammal Medical College Hospital and Research Institute, Madurai, 625 009, India

    Jagan Chandramohan

  4. NH MMI Hospital, Lalpur, Raipur, 492 001, India

    Abhishek Jain

  5. Department of Gastroenterology, All India Institute of Medical Sciences, Rishikesh, 249 203, India

    Itish Patnayak

  6. Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, 110 085, India

    Piyush Gupta

  7. Department of Gastroenterology, Yashoda Hospital, Hyderabad, 500 082, India

    Bharath K. Ayapati

  8. AMRI Hospital, Kolkata, 700 098, India

    Kaushik Chatterjee

Authors
  1. Amit Kumar Dutta
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Contributions

The first author (Amit Kumar Dutta) was responsible for design and conduct of study, image interpretation, data analysis, and manuscript preparation. Dr. Noriya Uedo was responsible for image interpretation, data analysis, manuscript preparation, and critical revision. Dr. Anna B. Pulimood and Dr. Jagan Chandramohan were responsible for histopathological assessment of polyp, data analysis, manuscript preparation, and critical revision of manuscript. The rest of the authors contribute to patient enrolment, data collection, manuscript preparation, and critical revision of the manuscript.

Corresponding author

Correspondence to Amit Kumar Dutta.

Ethics declarations

Conflict of interest

AKD, NU, DD, JC, AJ, IP, PG, BKA, KC, RJ. RTK, SDC, EGS, AJJ, and ABP declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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The study was carried out in the Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632 004, India. All authors (except Dr. Noriya Uedo) were affiliated with this institute during the period of research. Dr. Noriya Uedo’s affiliation during the research period was same as current affiliation (Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan).

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Dutta, A.K., Uedo, N., David, D. et al. Image-enhanced endoscopy for real-time differentiation between hyperplastic and fundic gland polyps in the stomach. Indian J Gastroenterol 41, 599–609 (2022). https://doi.org/10.1007/s12664-022-01278-9

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