Shoko Ono

Clinicopathological analysis of early-stage gastric cancers detected after successful eradication of Helicobacter pylori.

Background and Aims:  The results of a randomized controlled study and meta‐analysis study have recently proved that Helicobacter pylori eradication has a preventive effect against the development of metachronous and primary gastric cancer. However, gastric cancer is sometimes detected after successful eradication. There is a lack of study about gastric cancers in eradicated patients. To clarify the characteristics of gastric cancers detected after H. pylori eradication, we analyzed the clinicopathological features of these cancers.

Multicenter randomized controlled study to assess the effect of prophylactic clipping on post-polypectomy delayed bleeding.

Prophylactic clipping has been widely used to prevent post‐procedural bleeding in colon polypctomy. However, its efficiency has not been confirmed and there is no consensus on the usefulness of prophylactic clipping. The aim of the present study was to evaluate the preventive effect of prophylactic clipping on post‐polypectomy bleeding.

Vonoprazan improves the efficacy of Helicobacter pylori eradication therapy with a regimen consisting of clarithromycin and metronidazole in patients allergic to penicillin

Although all Helicobacter pylori (H. pylori)‐positive patients should receive eradication therapy, the therapy is a challenge for patients allergic to penicillin. There have been a few reports on the efficacy of eradication therapy for such patients.

Linked color imaging enhances gastric cancer in gastric intestinal metaplasia

Gastric intestinal metaplasia (GIM) is a high risk for intestinal type gastric cancer; however, there is a limitation for detection of GIM using white light imaging (WLI). Image-enhanced endoscopy (IEE) is more advantageous than WLI for optical diagnosis of GIM (1). Linked color imaging (LCI) (FUJIFILM Co., Tokyo, Japan) was newly developed for advanced IEE and enables visualization of red lesions that appear redder and whitish red lesions that appear whiter during routine endoscopy (2). GIM is observed as a lavender color that is distinguishable from the circumferential mucosa without GIM by using LCI (Figure 1). We speculate that the lavender color is the same as the bluish−whitish patchy areas including a light blue crest or a marginal turbid band in narrow band imaging (3, 4). On the other hand, gastric cancer is observed as lesions of various degrees of redness depending on the quantity of blood vessels. This article is protected by copyright. All rights reserved.

Gastric mucosal cracked and cobblestone-like changes resulting from proton pump inhibitor use

Use of proton pump inhibitors (PPI) is histologically associated with oxyntic gland dilatations. Two interesting mucosal changes are often detected endoscopically in patients who use PPI: gastric cracked mucosa (GCM) and gastric cobblestone‐like mucosa (GCSM). The aim of the present study was to clarify the relationship between PPI use and these mucosal changes.

Magnifying Blue Laser Imaging versus Magnifying Narrow-Band Imaging for the Diagnosis of Early Gastric Cancer: A Prospective, Multicenter, Comparative Study

Background/Aims: The diagnostic efficacy of magnifying blue laser imaging (M-BLI) and M-BLI in bright mode (M-BLI-bright) in the identification of early gastric cancer (EGC) was evaluated for comparison to that of magnifying narrow-band imaging (M-NBI). Methods: This prospective, multicenter study evaluated 114 gastric lesions examined using M-BLI, M-BLI-bright, and M-NBI between May 2012 and November 2012; 104 EGCs were evaluated by each modality. The vessel plus surface classification system was used to evaluate the demarcation line (DL), microvascular pattern (MVP), and microsurface pattern (MSP). Results: M-BLI, M-BLI-bright, and M-NBI revealed a DL for 96.1, 98.1, and 98.1% and irregular MVP for 95.1, 95.1, and 96.2% of lesions, respectively, with no significant difference. Irregular MSP was observed by M-BLI, M-BLI-bright, and M-NBI in 97.1, 90.4, and 78.8% of lesions, respectively, with significant differences (p < 0.001). The proportion of moderately differentiated adenocarcinoma with irregular MSP on M-BLI and absent MSP on M-NBI was significantly higher than that with irregular MSP on M-BLI and M-NBI (35.0 and 9.9%, respectively; p = 0.002). Conclusion: M-BLI and M-BLI-bright provided excellent visualization of microstructures and microvessels similar to M-NBI. Irregular MSP in a moderately differentiated adenocarcinoma might be frequently visualized using M-BLI and M-BLI-bright compared with using M-NBI.

Human intestinal spirochetosis is significantly associated with sessile serrated adenomas/polyps

It remains unclear whether or not human intestinal spirochetosis (HIS) has any associated symptoms or lesions. In this study, we assessed the prevalence of HIS in sessile serrated adenomas/polyps (SSA/Ps) and their possible association. Following identification of early cecal cancer with SSA/P accompanied by a colonization of HIS, we went on to conduct a retrospective case-control study using endoscopically resected SSA/P specimens to examine the frequency of HIS infection in SSA/Ps. Nineteen SSA/P cases and 172 controls were obtained. The rate of HIS infection was significantly higher at 52.6% (10/19) in the SSA/P cases compared to the controls at 8.1% (14/172). Our SSA/P series were associated with a remarkably higher rate of HIS than controls or than previously reported. This is the first report to provide evidence for potential association between HIS and SSA/Ps.

Metachronous gastric cancer following complete remission of gastric MALT lymphoma

Recently, there have been some reports on the long-term clinical outcome of gastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma) [1]. Localized gastric MALT lymphoma generally has a favorable prognosis; however, metachronous gastric cancers developed during our long-term follow-up. Two men were diagnosed with Helicobacter pylori-positive gastric MALT lymphoma and were classified as grade I and grade II1 according to the Rugano classification. Both patients achieved complete remission in 3 months after eradication therapy and have maintained this state. However, yearly followup endoscopy showed early-stage depressed-type gastric cancer at 5 and 8 years after remission of the lymphoma. Both carcinomas were resected by endoscopic surgery. One woman received radiation therapy (whole dose 30 Gy) to treat localized gastric MALT lymphoma, classified as grade II1. She was negative for H. pylori infection since she had been diagnosed as having MALT lymphoma 11 years ago. At the fifth year after radiation therapy, regular endoscopy revealed an early gastric cancer in the corpus, which was cured by endoscopic surgery. All three cases have maintained complete remission of the gastric MALT lymphoma but developed intestinal-type gastric cancer in the same areas where the MALT lymphoma had been eradicated. It is controversial whether gastric cancer risk is increased in patients with gastric MALT lymphoma, and there have been few reports on metachronous gastric cancer in patients, following remission of gastric MALT lymphoma [2].

Enrichment of Helicobacter pylori mutant strains after eradication therapy analyzed by gastric wash–based quantitative pyrosequencing

The eradication of Helicobacter pylori reduces the risk of gastric cancer. A clear understanding of the factors underlying mixed infection with multiple clarithromycin-susceptible and clarithromycin-resistant H. pylori strains is necessary to design more effective therapies against H. pylori. We aimed to assess how the abundance and prevalence of H. pylori strains vary after clarithromycin-based eradication therapy. Using gastric wash samples, which represent the entire stomach, we sequentially analyzed the abundance and prevalence of H. pylori DNA by 23S ribosomal RNA pyrosequencing before and 1, 2, and 3 years after eradication therapy. Low levels of H. pylori DNA were still detectable at the first-year follow-up in all samples with negative post-treatment urea breath test results. The abundance of H. pylori DNA decreased significantly until the 2-year follow-up, but it switched to an increase at the 3-year follow-up. Importantly, the ratio of the prevalence of mutant strains to the prevalence of wild-type strains had already increased at the first-year follow-up and continued to increase, suggesting the selection and growth of clarithromycin-resistant strains during the follow-up periods. Being sensitive and representative, our assay will be useful in effectively addressing gastric cancer development by enhancing the long-term success of intervention strategies and consecutive surveillance for H. pylori eradication.

Gastric Hyperplastic Polyps Associated with Proton Pump Inhibitor Use in a Case without a History of Helicobacter pylori Infection

A 56-year-old man with gastroesophageal reflux disease (GERD) was referred to our hospital. Esophagogastroduodenoscopy (EGD) revealed no evidence of any polypoid lesions in the stomach, and the patient had no history of Helicobacter pylori infection. He received omeprazole (20 mg) once daily for the GERD. EGD was performed at 1 year after the start of omeprazole administration, and this time, gastric hyperplastic polyps (GHPs) were detected. The GHPs increased in size as the omeprazole treatment continued, but they markedly decreased in size following omeprazole discontinuation. Thus, the administration of proton pump inhibitors may be a risk factor for the development of GHP independent of H. pylori infection.