Clinical Endoscopy

Clinicopathological and endoscopic features of Helicobacter pylori infection-negative gastric cancer in Japan: a retrospective study: Kentaro Imamura, Kenshi Yao, Satoshi Nimura, Takao Kanemitsu, Masaki Miyaoka, Yoichiro Ono, Toshiharu Ueki, Hiroshi Tanabe; Clin Endosc 2024;57(4):486-494. Published online March 22, 2024; DOI: https://doi.org/10.5946/ce.2023.258

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Background
/Aims: Helicobacter pylori infection-negative gastric cancer (HPNGC) has not been systematically investigated in consecutive patients. Hence, this study aimed to investigate the clinicopathological and endoscopic features of HPNGC.
Methods
This single-center retrospective study selected participants from patients with gastric cancer who were treated at the Fukuoka University Chikushi Hospital between January 2013 and December 2021. Only patients diagnosed with HPNGC were enrolled, and their clinicopathological and endoscopic features were analyzed in detail.
Results
The prevalence of HPNGC in the present study was 2.6% (54/2112). The types of HPNGC observed in each gastric region were as follows: advanced gastric cancer was observed in the cardia; gastric adenocarcinoma of fundic-gland differentiation, gastric adenocarcinoma of foveolar-type presenting with whitish elevation and raspberry-like foveolar-type gastric adenocarcinoma, gastric adenocarcinoma arising in polyposis, and gastric adenocarcinoma with autoimmune gastritis were observed in the fundic gland region ranging from the gastric fornix to the gastric body; signet-ring cell carcinoma was observed in the gastric-pyloric transition region ranging from the lower gastric body to the gastric angle; and well-differentiated tubular adenocarcinoma with low-grade atypia was observed in the antrum.
Conclusions
This study revealed that tumors from each gastric region exhibited distinct macroscopic and histological types in HPNGC.

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Is your endoscopist qualified enough to detect Helicobacter pylori-naive status?
Sun-Young Lee
Clinical Endoscopy.2024; 57(4): 466. CrossRef

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Association between occurrence of multiple white and flat elevated gastric lesions and oral proton pump inhibitor intake: Rino Hasegawa, Kenshi Yao, Takao Kanemitsu, Hisatomi Arima, Takayuki Hirase, Yuuya Hiratsuka, Kazuhiro Takeda, Kentaro Imamura, Kensei Ohtsu, Yoichiro Ono, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ohta, Satoshi Nimura; Clin Endosc 2024;57(1):65-72. Published online May 9, 2023; DOI: https://doi.org/10.5946/ce.2022.257

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Background
/Aims: Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL.
Methods
The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake.
Results
In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06–16.2).
Conclusions
Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).

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Endoscopic findings and outcomes of gastric mucosal changes relating to potassium‐competitive acid blocker and proton pump inhibitor therapy
Satoshi Shinozaki, Hiroyuki Osawa, Yoshimasa Miura, Hiroaki Nomoto, Hirotsugu Sakamoto, Yoshikazu Hayashi, Tomonori Yano, Edward J. Despott, Hironori Yamamoto
DEN Open.2025;[Epub] CrossRef
Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
Gwang Ha Kim
Clinical Endoscopy.2024; 57(1): 51. CrossRef
Drug-induced mucosal alterations observed during esophagogastroduodenoscopy
Masaya Iwamuro, Seiji Kawano, Motoyuki Otsuka
World Journal of Gastroenterology.2024; 30(16): 2220. CrossRef

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Efficacy of endoscopy under general anesthesia for the detection of synchronous lesions in oro-hypopharyngeal cancer: Yoichiro Ono, Kenshi Yao, Yasuhiro Takaki, Satoshi Ishikawa, Kentaro Imamura, Akihiro Koga, Kensei Ohtsu, Takao Kanemitsu, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Atsuko Ota, Hiroshi Tanabe, Seiji Haraoka, Satoshi Nimura, Akinori Iwashita, Susumu Sato, Rumie Wakasaki; Clin Endosc 2023;56(3):315-324. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.072

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Background
/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma.
Methods
This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia.
Results
Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness.
Conclusions
Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

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Nasopharyngeal examination during transoral upper gastrointestinal endoscopy
Vui Heng Chong
Clinical Endoscopy.2024; 57(1): 137. CrossRef
Endoscopy under general anesthesia for detecting synchronous lesions of head and neck squamous cell carcinoma
Jin Hee Noh, Do Hoon Kim
Clinical Endoscopy.2023; 56(3): 308. CrossRef

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Histological Architecture of Gastric Epithelial Neoplasias That Showed Absent Microsurface Patterns, Visualized by Magnifying Endoscopy with Narrow-Band Imaging: Kenta Chuman, Kenshi Yao, Takao Kanemitsu, Takashi Nagahama, Masaki Miyaoka, Haruhiko Takahashi, Kentaro Imamura, Rino Hasegawa, Toshiharu Ueki, Hiroshi Tanabe, Seiji Haraoka, Akinori Iwashita; Clin Endosc 2021;54(2):222-228. Published online November 24, 2020; DOI: https://doi.org/10.5946/ce.2020.090

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Background
/Aims: The objective of this study was to elucidate the histological structure of the absent microsurface patterns (MSPs) that were visualized by magnifying endoscopy with narrow-band imaging (M-NBI).
Methods
The study included consecutive gastric epithelial neoplasias for which M-NBI findings and histological findings could be compared on a one-to-one basis. The lesions were classified as absent MSPs and present MSPs based on the findings obtained using M-NBI. Of the histopathological findings for each lesion that corresponded to M-NBI findings, crypt opening densities, crypt lengths, crypt opening diameters, intercrypt distances, and crypt angles were measured and compared.
Results
Thirty-six lesions were included in the analysis; of these, 17 lesions exhibited absent MSP and 19 lesions exhibited present MSP. Comparing the histological measurements for absent MSPs vs. present MSPs, median crypt opening density was 0.9 crypt openings/mm vs. 4.8 crypt openings/mm (p<0.001), respectively. The median crypt length, median crypt opening diameter, median intercrypt distance, and median crypt angle were 80.0 μm vs. 160 μm (p<0.001), 40.0 μm vs. 44.2 μm (p=0.09), 572.5 μm vs. 166.7 μm (p<0.001), and 21.6 degrees vs. 15.5 degrees (p<0.001), respectively.
Conclusions
Histological findings showed that lesions exhibiting absent MSPs had lower crypt opening density, shorter crypt length, greater intercrypt distance, and larger crypt angle.

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The staining results of early gastric cancer by indigo carmine chromoendoscopy associated with histological structure: a retrospective study
Xiaosa Jiang, Lingzhi Qin, Yujie Hao, Qian Yang, Yueqin Zheng, Baicang Zou, Lei Dong, Na Liu, Jinhai Wang, Bin Qin
BMC Cancer.2024;[Epub] CrossRef
Magnifying Endoscopy with Narrow-Band Imaging for Duodenal Neuroendocrine Tumors
Gwang Ha Kim, Kiyoun Yi, Dong Chan Joo, Moon Won Lee, Hye Kyung Jeon, Bong Eun Lee
Journal of Clinical Medicine.2023; 12(9): 3106. CrossRef

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Magnified Endoscopic Findings of Multiple White Flat Lesions: A New Subtype of Gastric Hyperplastic Polyps in the Stomach: Rino Hasegawa, Kenshi Yao, Shoutomi Ihara, Masaki Miyaoka, Takao Kanemitsu, Kenta Chuman, Go Ikezono, Akikazu Hirano, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ota, Seiji Haraoka, Akinori Iwashita; Clin Endosc 2018;51(6):558-562. Published online November 21, 2018; DOI: https://doi.org/10.5946/ce.2018.104

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Background
/Aims: While the occurrence of multiple whitish flat elevated lesions (MWFL) was first reported in 2007, no studies on MWFL have been published to date. The present retrospective observational study aimed to clarify the endoscopic findings and clinicopathological features of MWFL.
Methods
Subjects were consecutive patients who underwent upper gastrointestinal endoscopy as part of routine screening between April 2014 and March 2015. The conventional white-light, non-magnifying and magnifying narrow-band images were reviewed. Clinical features were compared between patients with and without MWFL.
Results
The conventional endoscopic findings of MWFL include multiple whitish, flat, and slightly elevated lesions of various sizes, mainly located in the gastric body and fundus. Narrow-band imaging enhanced the contrast of MWFL and background mucosa, and magnifying narrow-band imaging depicted a uniformly long, narrow, and elliptical marginal crypt epithelium with an unclear microvascular pattern. Histopathological findings revealed hyperplastic changes of the foveolar epithelium, and parietal cell protrusions and oxyntic gland dilatations were observed in the fundic glands, without any intestinal metaplasia. The rate of acid-reducing drug use was significantly higher in patients with MWFL than in those without (100% [13/13] vs. 53.7% [88/164], p<0.001).
Conclusions
The present study indicated a relationship between the presence and endoscopic features of MWFL and history of acidreducing drug use.

Citations

Citations to this article as recorded by

Endoscopic findings and outcomes of gastric mucosal changes relating to potassium‐competitive acid blocker and proton pump inhibitor therapy
Satoshi Shinozaki, Hiroyuki Osawa, Yoshimasa Miura, Hiroaki Nomoto, Hirotsugu Sakamoto, Yoshikazu Hayashi, Tomonori Yano, Edward J. Despott, Hironori Yamamoto
DEN Open.2025;[Epub] CrossRef
Association between occurrence of multiple white and flat elevated gastric lesions and oral proton pump inhibitor intake
Rino Hasegawa, Kenshi Yao, Takao Kanemitsu, Hisatomi Arima, Takayuki Hirase, Yuuya Hiratsuka, Kazuhiro Takeda, Kentaro Imamura, Kensei Ohtsu, Yoichiro Ono, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ohta, Satoshi Nimura
Clinical Endoscopy.2024; 57(1): 65. CrossRef
Randomised clinical trial: 3-year interim analysis results of the VISION trial to evaluate the long-term safety of vonoprazan as maintenance treatment in patients with erosive oesophagitis
Ken Haruma, Yoshikazu Kinoshita, Takashi Yao, Ryoji Kushima, Junichi Akiyama, Nobuo Aoyama, Tatsuhiro Kanoo, Kouji Miyata, Naomi Kusumoto, Naomi Uemura
BMC Gastroenterology.2023;[Epub] CrossRef
Helicobacter pylori Eradication-Related Development of Multiple White and Flat Elevated Lesions in the Stomach
Akira Hokama, Mayumi Shiroma, Mami Tomiyama, Yuko Tasato, Maki Setake
Chonnam Medical Journal.2023; 59(3): 203. CrossRef
Differential diagnosis of superficial duodenal epithelial tumor and non-neoplastic lesion in duodenum by magnified endoscopic examination with image-enhanced endoscopy
Atsushi Nakayama, Motohiko Kato, Teppei Masunaga, Yoko Kubosawa, Yukie Hayashi, Mari Mizutani, Yoshiyuki Kiguchi, Motoki Sasaki, Yusaku Takatori, Noriko Matsuura, Makoto Mutaguchi, Kaoru Takabayashi, Naohisa Yahagi
Journal of Gastroenterology.2022; 57(3): 164. CrossRef
Gastric Corpus Hypertrophy with a Bleeding Hyperplastic Polyp in a Helicobacter pylori-naive Subject after Long-term Proton Pump Inhibitor Use
Jong Hyeon Jeong, Sun-Young Lee, Hye Seung Han
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(1): 63. CrossRef
The effect of proton pump inhibitors and vonoprazan on the development of ‘gastric mucosal redness’
Satoshi Shinozaki, Hiroyuki Osawa, Yoshimasa Miura, Yoshikazu Hayashi, Hirotsugu Sakamoto, Tomonori Yano, Alan Lefor, Hironori Yamamoto
Biomedical Reports.2022;[Epub] CrossRef
Changes in gastric morphology during long-term use of vonoprazan compared to proton pump inhibitors
S Shinozaki, H Osawa, Y Hayashi, H Sakamoto, Y Miura, AK Lefor, H Yamamoto
Singapore Medical Journal.2022; 63(5): 283. CrossRef
Image-enhanced endoscopy for real-time differentiation between hyperplastic and fundic gland polyps in the stomach
Amit Kumar Dutta, Noriya Uedo, Deepu David, Jagan Chandramohan, Abhishek Jain, Itish Patnayak, Piyush Gupta, Bharath K. Ayapati, Kaushik Chatterjee, Rajeeb Jaleel, Reuben T. Kurien, Sudipta D. Chowdhury, Ebby G. Simon, Anjilivelil J. Joseph, Anna B. Pulim
Indian Journal of Gastroenterology.2022; 41(6): 599. CrossRef
Characteristics of non-neoplastic epithelium that appears within gastric cancer with and without Helicobacter pylori eradication: A retrospective study
Hiroto Noda, Mitsuru Kaise, Ryuichi Wada, Eriko Koizumi, Kumiko Kirita, Kazutoshi Higuchi, Jun Omori, Teppei Akimoto, Osamu Goto, Hiroshi Kawachi, Katsuhiko Iwakiri, Sanjiv Mahadeva
PLOS ONE.2021; 16(3): e0248333. CrossRef
Proton Pump Inhibitor-Related Gastric Mucosal Changes
Gwang Ha Kim
Gut and Liver.2021; 15(5): 646. CrossRef
Gastric Hyperplastic Polyps: A Benign Entity? Analysis of Recurrence and Neoplastic Transformation in a Cohort Study
Mafalda João, Miguel Areia, Susana Alves, Luís Elvas, Filipe Taveira, Daniel Brito, Sandra Saraiva, Ana Teresa Cadime
GE - Portuguese Journal of Gastroenterology.2021; 28(5): 328. CrossRef
British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma
Matthew Banks, David Graham, Marnix Jansen, Takuji Gotoda, Sergio Coda, Massimiliano di Pietro, Noriya Uedo, Pradeep Bhandari, D Mark Pritchard, Ernst J Kuipers, Manuel Rodriguez-Justo, Marco R Novelli, Krish Ragunath, Neil Shepherd, Mario Dinis-Ribeiro
Gut.2019; 68(9): 1545. CrossRef
Multiple White Flat Lesions of the Corpus: Subtype of Hyperplastic Polyps vs. Intestinal Metaplasia
Su Jin Kim, Cheol Woong Choi
Clinical Endoscopy.2018; 51(6): 503. CrossRef

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