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Gao C, Zhang G, Zheng J, Zheng Y, Lin W, Xu G, You Y, Li D, Wang W. The value of LCI-based modified Kyoto classification risk scoring system in predicting the risk of early gastric cancer. Scand J Gastroenterol 2024; 59:859-867. [PMID: 38578144 DOI: 10.1080/00365521.2024.2338443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To study and compare the value of the Kyoto classification risk scoring system and the modified Kyoto classification risk scoring system based on linked color imaging (LCI) in predicting the risk of early gastric cancer. METHODS One hundred and fifty patients with pathologically confirmed non-cardia early gastric cancer by endoscopic LCI and 150 non-gastric cancer patients matched for age and gender were included. Basic patient data and whole gastric endoscopic images under LCI were collected, and the images were scored according to the LCI-based Kyoto classification risk scoring system and the LCI-based modified Kyoto classification risk scoring system. RESULTS Compared with the LCI-based Kyoto classification risk scoring system, the LCI-based modified Kyoto classification risk scoring system had a higher AUC for predicting the risk of early gastric cancer (0.723 vs. 0.784, p = 0.023), with a score of ≥3 being the best cutoff value for predicting the risk of early gastric cancer (sensitivity 61.33%, specificity 86.00%), and scores of 3 to 5 were significantly associated with early gastric carcinogenesis significantly (OR = 9.032, 95% CI: 4.995-16.330, p < 0.001). CONCLUSIONS Compared with the LCI-based Kyoto classification risk scoring system, the LCI-based Kyoto modified classification risk scoring system has a better value for predicting the risk of early gastric cancer, and the score of 3 to 5 is a high-risk factor for the risk of early gastric cancer development, which is more strongly correlated with the risk of early gastric cancer.
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Affiliation(s)
- Chao Gao
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Guanpo Zhang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Jin Zheng
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Yunmeng Zheng
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Wulian Lin
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Guilin Xu
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Yixiang You
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Dazhou Li
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Wen Wang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
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Matsumoto S, Sugimoto M, Fukuzawa M, Uesugi N, Iwata E, Kagawa Y, Madarame A, Koyama Y, Morise T, Uchida K, Yamaguchi H, Kono S, Naito S, Kawai T, Itoi T. Risk of map-like redness development after eradication therapy for Helicobacter pylori infection. Helicobacter 2024; 29:e13046. [PMID: 38984721 DOI: 10.1111/hel.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 07/11/2024]
Abstract
BACKGROUND Map-like redness is a newly identified endoscopic risk factor for gastric cancer in patients who received Helicobacter pylori eradication therapy. However, the incidence rate of map-like redness in patients who received eradication, and the risk factors for the development of map-like redness remain unclear. We hence aimed to investigate the incidence rate of map-like redness at 1-year post H. pylori eradication, and evaluated its associations with map-like redness and gastric cancer in relation with gastric condition. MATERIALS AND METHODS Endoscopic severity of gastritis and map-like redness were retrospectively evaluated according to the Kyoto Classification of Gastritis in patients who had undergone endoscopy before and after H. pylori eradication therapy. RESULTS The incidence rate of map-like redness for all 328 patients at a mean of 1.2 ± 0.6 years after eradication was 25.3% (95% confidence interval [CI]: 20.7%-30.4%). Patients who developed map-like redness were older, had more severe atrophy and intestinal metaplasia, a higher total score of the Kyoto Classification of Gastritis both before and after eradication, and a higher rate of gastric cancer history than patients who did not have map-like redness. On multivariate analysis, risk of map-like redness was increased in patients with intestinal metaplasia (odds ratio [OR]: 2.794, 95% CI: 1.155-6.757) and taking acid inhibitors (OR: 1.948, 95% CI: 1.070-3.547). Characteristics of H. pylori-positive patients with gastric cancer history were patients who were older (OR: 1.033, 95% CI: 1.001-1.066), taking acid inhibitors (OR: 4.456, 95% CI: 2.340-8.484), and with occurrence of map-like redness after eradication therapy (OR: 2.432, 95% CI: 1.264-4.679). CONCLUSIONS Map-like redness is observed in one fourth of patients at 1-year post eradication. Patients who developed map-like redness were found to have severe intestinal metaplasia and taking acid inhibitors, and hence such patients require increased attention at surveillance endoscopy.
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Affiliation(s)
- Sho Matsumoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Nana Uesugi
- Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Eri Iwata
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yasuyuki Kagawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Akira Madarame
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yohei Koyama
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takashi Morise
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kumiko Uchida
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hayato Yamaguchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Shin Kono
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Sakiko Naito
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
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3
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Sousa C, Ferreira R, Santos SB, Azevedo NF, Melo LDR. Advances on diagnosis of Helicobacter pylori infections. Crit Rev Microbiol 2023; 49:671-692. [PMID: 36264672 DOI: 10.1080/1040841x.2022.2125287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022]
Abstract
The association of Helicobacter pylori to several gastric diseases, such as chronic gastritis, peptic ulcer disease, and gastric cancer, and its high prevalence worldwide, raised the necessity to use methods for a proper and fast diagnosis and monitoring the pathogen eradication. Available diagnostic methods can be classified as invasive or non-invasive, and the selection of the best relies on the clinical condition of the patient, as well as on the sensitivity, specificity, and accessibility of the diagnostic test. This review summarises all diagnostic methods currently available, including the invasive methods: endoscopy, histology, culture, and molecular methods, and the rapid urease test (RUT), as well as the non-invasive methods urea breath test (UBT), serological assays, biosensors, and microfluidic devices and the stool antigen test (SAT). Moreover, it lists the diagnostic advantages and limitations, as well as the main advances for each methodology. In the end, research on the development of new diagnostic methods, such as bacteriophage-based H. pylori diagnostic tools, is also discussed.
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Affiliation(s)
- Cláudia Sousa
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga/Guimarães, Portugal
| | - Rute Ferreira
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga/Guimarães, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Sílvio B Santos
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno F Azevedo
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| | - Luís D R Melo
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga/Guimarães, Portugal
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Syam AF, Miftahussurur M, Makmun D, Abdullah M, Rani AA, Siregar GA, Simadibrata M, Zubir N, Dewa Nyoman Wibawa I, Purnomo HD, Manan C, Djojoningrat D, Fauzi A, Renaldi K, Maulahela H, Utari AP, Pribadi RR, Muzellina VN, Nursyirwan SA, Idrus MF, Ruswhandi R, Sugihartono T, Bestari MB, Bayupurnama P, Pramana TY, Wibowo BP, Bakry AF, Akil F, Parewangi AML, Widita H, Mariadi IK, Murti IS, Yusuf AI, Arles A, Yusuf F, Waleleng BJ, Abimanyu A, Mulyadi Y, Lucida MI, Rezkhita YAA, Alfaray RI, Yamaoka Y. Management of dyspepsia and Helicobacter pylori infection: the 2022 Indonesian Consensus Report. Gut Pathog 2023; 15:25. [PMID: 37217981 DOI: 10.1186/s13099-023-00551-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
Dyspepsia still becomes a major challenge in upper gastrointestinal disease in Indonesia. This disease often correlated with Helicobacter pylori infection. However, the prevalence of this bacterium is generally low in Indonesia. Therefore, several considerations should be taken into consideration during the management of dyspepsia and H. pylori infection. "Management of dyspepsia and H. pylori infection in Indonesia: The Indonesian consensus report" comprises information gathered from 22 gastroenterology centers across Indonesia. The experts gathered to evolve a consensus, that consists of the statements, grades of recommendations, evidence levels, and rationales for the dyspepsia and H. pylori infection management for daily clinical practice. The report explains several aspects from the updated epidemiology information to comprehensive management therapy. After the experts worked together on all statements in the recommendations, the results are presented with the final agreement as a consensus to help clinicians in understanding, diagnosing, and treating dyspepsia and H. pylori infection patients in daily clinical practice in Indonesia.
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Affiliation(s)
- Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia.
| | - Muhammad Miftahussurur
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia.
- Helicobacter Pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.
| | - Dadang Makmun
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Abdul Aziz Rani
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Gontar Alamsyah Siregar
- Division of Gastroenterohepatology, Department of Internal Medicine, Adam Malik General Hospital/Faculty of Medicine, Sumatra Utara University, Medan, Indonesia
| | - Marcellus Simadibrata
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Nasrul Zubir
- Division of Gastroenterohepatology, Department of Internal Medicine, M. Djamil General Hospital/Faculty of Medicine, Andalas University, Padang, Indonesia
| | - I Dewa Nyoman Wibawa
- Division of Gastroenterohepatology, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Bali, Denpasar, Indonesia
| | - Hery Djagat Purnomo
- Division of Gastroenterohepatology, Department of Internal Medicine, Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Chudahman Manan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Dharmika Djojoningrat
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Achmad Fauzi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Kaka Renaldi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Hasan Maulahela
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Amanda Pitarini Utari
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Rabbinu Rangga Pribadi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Virly Nanda Muzellina
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Saskia Aziza Nursyirwan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Muhammad Firhat Idrus
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Ruswhandi Ruswhandi
- Department of Internal Medicine, Gatot Subroto Army Central Hospital, Jakarta, Indonesia
| | - Titong Sugihartono
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Begawan Bestari
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital/Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Putut Bayupurnama
- Division of Gastroenterohepatology, Department of Internal Medicine, Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Triyanta Yuli Pramana
- Division of Gastroenterohepatology, Department of Internal Medicine, Moewardi General Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Bogi Pratomo Wibowo
- Division of Gastroenterohepatology, Department of Internal Medicine, Saiful Anwar General Hospital/Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Achmad Fuad Bakry
- Division of Gastroenterohepatology, Department of Internal Medicine, Moch. Hoesin General Hospital/Faculty of Medicine, Sriwijaya University, Palembang, Indonesia
| | - Fardah Akil
- Division of Gastroenterohepatology, Department of Internal Medicine, Wahidin Sudirohusodo General Hospital/Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Andi Muhammad Luthfi Parewangi
- Division of Gastroenterohepatology, Department of Internal Medicine, Wahidin Sudirohusodo General Hospital/Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Haris Widita
- Department of Internal Medicine, West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - I Ketut Mariadi
- Division of Gastroenterohepatology, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Bali, Denpasar, Indonesia
| | - Ignatia Sinta Murti
- Department of Internal Medicine, Abdul Wahab Sjahranie General Hospital/Faculty of Medicine, Mulawarman University, Samarinda, Indonesia
| | - Ali Imron Yusuf
- Department of Internal Medicine, Abdoel Moeloek General Hospital/Faculty of Medicine, Lampung University, Lampung, Indonesia
| | - Arles Arles
- Department of Internal Medicine, Awal Bros Pekanbaru Hospital, Pekanbaru, Indonesia
| | - Fauzi Yusuf
- Division of Gastroenterohepatology, Department of Internal Medicine, Zainoel Abidin General Hospital/Faculty of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Bradley Jimmy Waleleng
- Division of Gastroenterohepatology, Department of Internal Medicine, Prof. R. D. Kandou General Hospital/Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | - Abimanyu Abimanyu
- Department of Internal Medicine, Ulin Banjarmasin General Hospital, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia
| | - Yustar Mulyadi
- Department of Internal Medicine, Soedarso General Hospital, Pontianak, Indonesia
| | - Maria Inge Lucida
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Yudith Annisa Ayu Rezkhita
- Helicobacter Pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Muhammadiyah Surabaya, Surabaya, Indonesia
| | - Ricky Indra Alfaray
- Helicobacter Pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan
- The Research Center for GLOBAL and LOCAL Infectious Diseases (RCGLID), Oita University, Oita, Japan
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, USA
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Seo JY, Hong H, Ryu WS, Kim D, Chun J, Kwak MS. Development and validation of a convolutional neural network model for diagnosing Helicobacter pylori infections with endoscopic images: a multicenter study. Gastrointest Endosc 2023; 97:880-888.e2. [PMID: 36641124 DOI: 10.1016/j.gie.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Insufficient validation limits the generalizability of deep learning in diagnosing Helicobacter pylori infection with endoscopic images. The aim of this study was to develop a deep learning model for the diagnosis of H pylori infection using endoscopic images and validate the model with internal and external datasets. METHODS A convolutional neural network (CNN) model was developed based on a training dataset comprising 13,403 endoscopic images from 952 patients who underwent endoscopy at Seoul National University Hospital Gangnam Center. Internal validation was performed using a separate dataset comprised of images of 411 individuals of Korean descent and 131 of non-Korean descent. External validation was performed with the images of 160 patients in Gangnam Severance Hospital. Gradient-weighted class activation mapping was performed to visually explain the model. RESULTS In predicting H pylori ever-infected status, the sensitivity, specificity, and accuracy of internal validation for people of Korean descent were .96 (95% confidence interval [CI], .93-.98), .90 (95% CI, .85-.95), and .94 (95% CI, .91-.96), respectively. In the internal validation for people of non-Korean descent, the sensitivity, specificity, and accuracy in predicting H pylori ever-infected status were .92 (95% CI, .86-.98), .79 (95% CI, .67-.91), and .88 (95% CI, .82-.93), respectively. In the external validation cohort, sensitivity, specificity, and accuracy were .86 (95% CI, .80-.93), .88 (95% CI, .79-.96), and .87 (95% CI, .82-.92), respectively, when performing 2-group categorization. Gradient-weighted class activation mapping showed that the CNN model captured the characteristic findings of each group. CONCLUSIONS This CNN model for diagnosing H pylori infection showed good overall performance in internal and external validation datasets, particularly in categorizing patients into the never- versus ever-infected groups.
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Affiliation(s)
- Ji Yeon Seo
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hotak Hong
- Artificial Intelligence Research Center, JLK Inc, Seoul, Republic of Korea
| | - Wi-Sun Ryu
- Artificial Intelligence Research Center, JLK Inc, Seoul, Republic of Korea
| | - Dongmin Kim
- Artificial Intelligence Research Center, JLK Inc, Seoul, Republic of Korea
| | - Jaeyoung Chun
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Sun Kwak
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
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Sugimoto M, Kawai Y, Morino Y, Hamada M, Iwata E, Niikura R, Nagata N, Koyama Y, Fukuzawa M, Itoi T, Kawai T. Efficacy of high-vision transnasal endoscopy using texture and colour enhancement imaging and narrow-band imaging to evaluate gastritis: a randomized controlled trial. Ann Med 2022; 54:1004-1013. [PMID: 35441573 PMCID: PMC9987448 DOI: 10.1080/07853890.2022.2063372] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A new image-enhanced endoscopy method called texture and colour enhancement imaging (TXI) enhances brightness, surface irregularities, and subtle colour changes in endoscopic images. However, it is unclear whether TXI and narrow-band imaging (NBI) with third-generation high-vision transnasal ultrathin endoscopy are advantageous over white-light imaging (WLI) for detecting atrophy, intestinal metaplasia, map-like redness and gastric cancer. We investigated to compare the endoscopic efficacy for evaluation of gastritis between TXI and NBI with high-vision transnasal endoscopy and clarified the endoscopic efficacy of TXI and NBI compared to WLI. METHODS We enrolled 60 patients who underwent high-vision transnasal endoscopy as part of a health check-up from March to November 2021 and randomized patients into two groups (the WLI-NBI group and the WLI-TXI group) using the minimization method based on Helicobacter pylori infection status, age and sex. Colour differences determined using the International Commission on Illumination 1976 (L∗, a∗, b∗) colour space was compared between WLI and TXI or NBI. RESULTS No significant differences were observed in colour differences surrounding atrophy, intestinal metaplasia and map-like redness between NBI and TXI (p = .553, .057 and .703, respectively). Endoscopic scores based on the Kyoto classification of gastritis for atrophy, intestinal metaplasia, and map-like redness were similar between WLI and TXI. In contrast, NBI identified intestinal metaplasia at a significantly greater rate than WLI (p = .018). Further, colour differences surrounding atrophy and intestinal metaplasia on TXI and NBI were significantly greater than those on WLI (atrophy: TXI vs WLI p = .003, NBI vs WLI p < .001; intestinal metaplasia: TXI vs WLI p = .016, NBI vs WLI p < .001). However, TXI and NBI were not advantageous over WLI for detecting map-like redness. CONCLUSION Third-generation high-vision transnasal ultrathin endoscopy using TXI and/or NBI is useful for detecting atrophic borders and intestinal metaplasia.Key MessagesHigh-vision transnasal endoscopy using TXI or NBI is useful for diagnosing and detecting atrophy and intestinal metaplasia.TXI and NBI increase colour differences surrounding atrophy and intestinal metaplasia, thereby increasing diagnostic efficiency to improve risk stratification for gastric cancer.The image quality and detection rate have improved markedly with the latest ultrathin high-vision transnasal endoscopes.
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Affiliation(s)
- Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yusuke Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuko Morino
- Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Mariko Hamada
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Eri Iwata
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yohei Koyama
- Department of Gastroenterology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
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Toyoshima O, Nishizawa T. Kyoto classification of gastritis: Advances and future perspectives in endoscopic diagnosis of gastritis. World J Gastroenterol 2022; 28:6078-6089. [PMID: 36483157 PMCID: PMC9724483 DOI: 10.3748/wjg.v28.i43.6078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
This editorial provides an update of the recent evidence on the endoscopy-based Kyoto classification of gastritis, clarifying the shortcomings of the Kyoto classification, and providing prospects for future research, with particular focus on the histological subtypes of gastric cancer (GC) and Helicobacter pylori (H. pylori) infection status. The total Kyoto score is designed to express GC risk on a score ranging from 0 to 8, based on the following five endoscopic findings: Atrophy, intestinal metaplasia (IM), enlarged folds (EF), nodularity, and diffuse redness (DR). The total Kyoto score reflects H. pylori status as follows: 0, ≥ 2, and ≥ 4 indicate a normal stomach, H. pylori-infected gastritis, and gastritis at risk for GC, respectively. Regular arrangement of collecting venules (RAC) predicts non-infection; EF, nodularity, and DR predict current infection; map-like redness (MLR) predicts past infection; and atrophy and IM predict current or past infection. Atrophy, IM, and EF all increase the incidence of H. pylori-infected GC. MLR is a specific risk factor for H. pylori-eradicated GC, while RAC results in less GC. Diffuse-type GC can be induced by active inflammation, which presents as EF, nodularity, and atrophy on endoscopy, as well as neutrophil and mononuclear cell infiltration on histology. In contrast, intestinal-type GC develops via atrophy and IM, and is consistent between endoscopy and histology. However, this GC risk-scoring design needs to be improved.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
- Department of Gastroenterology and Hepatology, International University of Medicine and Welfare, Narita 286-8520, Japan
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Comparative Study of Helicobacter pylori-Infected Gastritis in Okinawa and Tokyo Based on the Kyoto Classification of Gastritis. J Clin Med 2022; 11:jcm11195739. [PMID: 36233607 PMCID: PMC9571441 DOI: 10.3390/jcm11195739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/25/2022] [Accepted: 09/25/2022] [Indexed: 12/24/2022] Open
Abstract
The incidence of gastric cancer in Okinawa Prefecture is the lowest in Japan, which is attributed to differences in strains of Helicobacter pylori in Okinawa and other prefectures in Japan. Our aim was to compare the endoscopic findings of H. pylori-infected gastric mucosa in Okinawa and Tokyo. Patients who underwent upper gastrointestinal endoscopy (UGI) at Northern Okinawa Medical Center (Okinawa group) and Juntendo University Hospital (Tokyo group) from April 2019 to March 2020 were included. Patients diagnosed with H. pylori-infected gastric mucosa were retrospectively compared between the Okinawa and Tokyo groups according to the Kyoto Classification of Gastritis. The numbers of subjects (Okinawa/Tokyo) were 435/352, male/female ratio was 247:188/181:171, and age was 53.3 ± 14.7/64.6 ± 14.3 (mean ± standard deviation) years. Regarding the Kyoto Classification of Gastritis, the prevalence (Okinawa/Tokyo) of the closed type of atrophic gastritis was 73%/37% (p < 0.001), diffuse redness 80%/84% (p = 0.145), mucosal swelling 46%/46% (p = 0.991), enlarged fold 26%/32% (p = 0.048), spotty redness 77%/68% (p = 0.002), sticky mucus 17%/36% (p < 0.001), and intestinal metaplasia 32%/42% (p < 0.001). Age analysis also revealed that closed-type atrophy and spotty redness were more frequent in the Okinawa group than in the Tokyo group. There may be regional differences in endoscopic findings of H. pylori-infected gastric mucosa between Okinawa and Tokyo.
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Dawod HM. A prospective study for evaluating the effect of gastric targeted biopsy sampling with I‐scan optical enhancement on the diagnostic yield of CLOtest for
Helicobacter pylori
infection. Health Sci Rep 2022; 5:e621. [PMID: 35509392 PMCID: PMC9059199 DOI: 10.1002/hsr2.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 01/06/2023] Open
Abstract
Background and Aim of the Work Helicobacter pylorigastritis can cause serious adverse effects in the short and long term. I‐scan optical enhancement (OE) has a potential role to distinguish areas of infected mucosa and allow for targeted biopsy. It improves visual contrast and mucosal pattern characterization. The work aims to determine if the diagnostic yield of the CLOtest could be improved by using endoscopic I‐scan OE technology for targeted gastric biopsy sampling. Patients and Methods A prospective study recruited 112 adult patients with active H. pylori infection diagnosed by C13 UBT at Nizwa General Hospital from March 2021 to January 2022. The patients underwent a careful examination by nonmagnifying upper endoscopy and I‐scan OE 3 moods, then randomly allocated into two groups. Group A: nontargeted double biopsies from the antrum and mid corpus. Group B: I‐scan OE‐directed targeted biopsy from abnormal mucosal patterns. The biopsy specimens were inoculated into CLOtest kits; the reading time of the positive results was at 1, 4, and 24 h. Results Group B had a 92.8% positive CLOtest compared to 89.3% in group A (p = 0.501). One‐hour CLOtest was positive in 78.5% of the patients in group B compared to 60.7% in group A (p = 0.047), while group A had a significantly more positive CLOtest at 24 h. Conclusion Sampling a targeted gastric biopsy with the aid of I‐scan ‐OE for CLOtest significantly hastens the positive reading time with high sensitivity.
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Affiliation(s)
- Hosam Mohamed Dawod
- Tropical Medicine Department, Faculty of Medicine Zagazig University Al Sharkia Egypt
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Quach DT, Aoki R, Iga A, Le QD, Kawamura T, Yamashita K, Tanaka S, Yoshihara M, Hiyama T. Diagnostic Accuracy of H. pylori Status by Conventional Endoscopy: Time-Trend Change After Eradication and Impact of Endoscopic Image Quality. Front Med (Lausanne) 2022; 8:830730. [PMID: 35155488 PMCID: PMC8831333 DOI: 10.3389/fmed.2021.830730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Aim To assess the time trend of diagnostic accuracy of pre- and post-eradication H. pylori status and interobserver agreement of gastric atrophy grading. Methods A series 100 of conventional endoscopic image sets taken from subjects undergoing gastric cancer screening at a polyclinic were evaluated by 5 experienced assessors. Each assessor independently examined endoscopic findings according to the Kyoto classification and then determined the H. pylori status (never, current, or past infected). Gastric atrophy was assessed according to the Kimura-Takemoto classification and classified into 3 grades (none/mild, moderate, or severe). The image series that ≥3 assessors considered to have good quality were arbitrarily defined as high-quality image (HQI) series, and the rest were defined as low-quality image (LQI) series. Results The overall diagnostic accuracy of H. pylori status was 83.0%. It was lowest in subjects with current infection (54%), gradually increased at 1 year (79%, P < 0.001) and 3 years (94.0%, P = 0.002), but then did not significantly change at 5 years (91.0%, P = 0.420) after eradication. The rate of LQI series was 28%. The overall diagnostic accuracy of H. pylori status dropped from 88.9% to 67.9% (P < 0.001), and the mean kappa value on gastric atrophy grading dropped from 0.730 to 0.580 (P = 0.002) in the HQI and LQI series, respectively. Conclusions Diagnostic accuracy of H. pylori status increased over time after eradication. LQI series badly affected the diagnostic accuracy of H. pylori status and the level of agreement when grading gastric atrophy.
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Affiliation(s)
- Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh, Vietnam
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam
- *Correspondence: Duc Trong Quach
| | - Rika Aoki
- Department of Internal Medicine, Tokushima Health Screening Center, Tokushima, Japan
| | - Akiko Iga
- Department of Internal Medicine, Matsuyama-Joto Hospital, Matsuyama, Japan
| | - Quang Dinh Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh, Vietnam
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam
| | - Toru Kawamura
- Department of Internal Medicine, Kawamura Internal Medicine Clinic, Hiroshima, Japan
| | - Ken Yamashita
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Toru Hiyama
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
- Toru Hiyama
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Nagahara A, Shiotani A, Iijima K, Kamada T, Fujiwara Y, Kasugai K, Kato M, Higuchi K. The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract). Dig Endosc 2022; 34:63-72. [PMID: 33772880 DOI: 10.1111/den.13982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
The Japan Gastroenterological Endoscopy Society held four serial symposia between 2019 and 2020 on the state-of-the-art of issues related to upper GI inflammatory diseases. This review discusses some of the topics addressed in these symposia. The papers regarding nonerosive reflux disease, recent improvements in intraesophageal pH-impedance monitoring and endoscopic diagnosis using image-enhanced endoscopy have been published. Many publications have addressed its usefulness in endoscopic treatment of gastroesophageal reflux disease such as anti-reflux mucosectomy. In the management of eosinophilic esophagitis, since the symptoms are subjective, objective indicators have been sought, and ultrasonography and high-resolution manometry may be useful tools for evaluation. The natural course of this condition, especially of asymptomatic cases, is not well clarified. Some newly developed anti-acid or anti-inflammatory medicines are now under investigation. With regard to autoimmune gastritis, because of widespread medical examinations, diagnosis of asymptomatic cases has been increasing. Recently, its endoscopic characteristics have become clear and the natural history of these conditions is being elucidated. The Kyoto Classification of Gastritis has been reported to be useful not only for Helicobacter pylori diagnosis but also for identification of risks of gastric cancer. Its usefulness is now recognized in Asia and Europe.
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Affiliation(s)
- Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akiko Shiotani
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University School of Medicine, Akita, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hokkaido, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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