Abstract
Purpose
Diagnosis of chronic atrophic fundal gastritis (CAFG) is important to understand the pathogenesis of gastric diseases and assess the risk of gastric cancer. Autofluorescence imaging videoendoscopy (AFI) may enable the detection of mucosal features not apparent by conventional white-light endoscopy. The purpose of this study was to estimate the diagnostic ability of AFI in CAFG.
Methods
A total of 77 patients were enrolled. Images of the gastric body in AFI and white-light mode were taken to assess the extent of gastritis, and biopsies were taken from green (n = 119) and purple (n = 146) mucosa in AFI images. The diagnostic accuracy of green mucosa for CAFG was investigated according to the Sydney system.
Results
In per-patient analysis, the accuracy of green mucosa in patients with activity, inflammation, atrophy and intestinal metaplasia was 64, 93, 88 and 81%, respectively. In per-biopsy analysis, the accuracy for activity, inflammation, atrophy and intestinal metaplasia was 55, 62, 76 and 76%, respectively. Green areas in the gastric body exhibited more inflammation (p < 0.001), atrophy (p < 0.001) and intestinal metaplasia (p < 0.001), whereas purple areas rarely contained atrophy or intestinal metaplasia. The kappa statistics for inter- and intra-observer agreement of AFI on assessing the extent of CAFG were 0.66 and 0.47, while those for white-light endoscopy were 0.56 and 0.39.
Conclusions
AFI could diagnose the extent of CAFG as a green area in the gastric body, with higher reproducibility compared with white-light endoscopy. Therefore, AFI may be a useful adjunct to endoscopy to identify patients at high risk of developing gastric cancer.
Similar content being viewed by others
References
Correa P. Chronic gastritis as a cancer precursor. Scand J Gastroenterol. 1984;104(Suppl.):131–6.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20:1161–81.
Bah A, Saraga E, Armstrong D, Vouillamoz D, Dorta G, Duroux P, et al. Endoscopic features of Helicobacter pylori-related gastritis. Endoscopy. 1995;27:593–6.
Laine L, Cohen H, Sloane R, Marin-Sorensen M, Weinstein WM. Interobserver agreement and predictive value of endoscopic findings for H. pylori and gastritis in normal volunteers. Gastrointest Endosc. 1995;42:420–3.
Tatsuta M, Saegusa T, Okuda S. Extension of fundal gastritis studied by endoscopic Congo-red test. Endoscopy. 1974;6:20–6.
Tatsuta M, Iishi H, Nakaizumi A, Okuda S, Taniguchi H, Hiyama T, et al. Fundal atrophic gastritis as a risk factor for gastric cancer. Int J Cancer. 1993;53:70–4.
Tatsuta M, Okuda S. Location, healing, and recurrence of gastric ulcers in relation to fundal gastritis. Gastroenterology. 1975;69:897–902.
Tatsuta M, Iishi H, Okuda S. Gastric emptying in patients with fundal gastritis and gastric cancer. Gut. 1990;31:767–9.
Tatsuta M, Okuda S, Tamura H, Taniguchi H. Polyps in the acid-secreting area of the stomach. Gastrointest Endosc. 1981;27:145–9.
Tóth E, Sjölund K, Fork FT, Lindstrom C. Chronic atrophic fundic gastritis diagnosed by a modified Congo red test. Endoscopy. 1995;27:654–8.
Tóth E, Sjölund K, Thorsson O, Thorlacius H. Evaluation of gastric acid secretion at endoscopy with a modified Congo red test. Gastrointest Endosc. 2002;56:254–9.
Haringsma J, Tytgat GN, Yano H, Iishi H, Tatsuta M, Ogihara T, et al. Autofluorescence endoscopy: feasibility of detection of GI neoplasms unapparent to white light endoscopy with an evolving technology. Gastrointest Endosc. 2001;53:642–50.
Uedo N, Iishi H, Tatsuta M, Yamada T, Ogiyama H, Imanaka K, et al. A novel videoendoscopy system by using autofluorescence and reflectance imaging for diagnosis of esophagogastric cancers. Gastrointest Endosc. 2005;62:521–8.
Uedo N, Iishi H, Ishihara R, Higashino K, Takeuchi Y. Novel autofluorescence videoendoscopy imaging system for diagnosis of cancers in the digestive tract. Dig Endosc. 2006;18(Suppl. 1):S131–6.
Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;3:87–97.
Redeen S, Petersson F, Jonsson KA, Borch K. Relationship of gastroscopic feature to histological findings in gastritis and Helicobacter pylori infection in a general population sample. Endoscopy. 2003;35:946–50.
Kaminishi M, Yamaguchi H, Nomura S, et al. Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis. Dig Endosc. 2002;14:138–51.
Rugge M, Farinati F, Baffa R, Sonego F, Di Mario F, Leandro G, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: a multicenter prospective follow-up study. Gastroenterology. 1994;107:1288–96.
Uedo N, Ishihara R, Iishi H, Yamamoto S, Yamamoto S, Yamada T, et al. A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy. 2006;38:819–24.
Kato M, Uedo N, Iishi H. Analysis of color pattern of early gastric cancer by autofluorescence imaging videoendoscopy system. Gastrointest Endosc. 2007;65:AB356.
Conflict of interest statement
There are no conflicts of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Inoue, T., Uedo, N., Ishihara, R. et al. Autofluorescence imaging videoendoscopy in the diagnosis of chronic atrophic fundal gastritis. J Gastroenterol 45, 45–51 (2010). https://doi.org/10.1007/s00535-009-0150-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-009-0150-7