Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Pathology, Cancer Institute Hospital, Tokyo, Japan.
J Gastroenterol. 2017 Sep;52(9):1023-1030. doi: 10.1007/s00535-017-1307-4. Epub 2017 Jan 12.
It is unknown whether Helicobacter pylori (H. pylori) eradication is beneficial when demarcating undifferentiated-type early gastric cancers (UD-type EGCs). This study aimed to determine whether H. pylori eradication is beneficial, and also when benefits become detectable.
Sixty lesions that were detected as a ≤20-mm lesion without metastasis or ulceration on routine examination, diagnosed as UD-type EGC on biopsy, and treated with endoscopic submucosal dissection between January 2010 and January 2015 were studied. Magnifying endoscopy with narrow-band imaging (ME-NBI) was performed to demarcate the lesions. The most oral and most anal sites were marked. After endoscopic therapy, the markings were compared with the pathological examination results to calculate accurate diagnosis rates, which were compared between 27 patients with H. pylori eradication and 33 patients without. Mean intercrypt distance ratio and inflammatory cell infiltration were also compared, as were seven patients who underwent the procedure 1 month after H. pylori eradication and 20 patients who underwent the procedure more than 1 month after H. pylori eradication.
Accurate diagnosis rates were 92.2% with eradication and 60.6% without. Mean intercrypt distance ratios were 1.95 and 1.59, respectively. Neutrophil infiltration was mild in the eradication group. Significant differences were observed in each parameter (p < 0.05). No significant difference was observed between the 1-month eradication and >1-month eradication subgroups in terms of accurate diagnosis rate, mean intercrypt distance ratio, or histological grade of any item.
This study suggests that H. pylori eradication therapy aids the accurate delineation of UD-type EGC in ME-NBI.
在界定未分化型早期胃癌（UD 型 EGC）时，是否消除幽门螺杆菌（H. pylori）有益尚不清楚。本研究旨在确定 H. pylori 消除是否有益，以及何时可以检测到益处。
研究了 60 例病变，这些病变在常规检查中被检测为无转移或溃疡的≤20mm 病变，活检诊断为 UD 型 EGC，并在 2010 年 1 月至 2015 年 1 月期间接受内镜黏膜下剥离术治疗。进行放大内镜窄带成像（ME-NBI）以划定病变。标记最口腔和最肛门部位。内镜治疗后，将标记与病理检查结果进行比较，计算准确诊断率，并在 27 例 H. pylori 根除患者和 33 例无 H. pylori 根除患者之间进行比较。还比较了平均隐窝间距离比和炎症细胞浸润，以及在 H. pylori 根除后 1 个月接受该手术的 7 例患者和 H. pylori 根除后 1 个月以上接受该手术的 20 例患者之间的比较。
根除组的准确诊断率为 92.2%，无根除组为 60.6%。平均隐窝间距离比分别为 1.95 和 1.59。根除组中性粒细胞浸润较轻。各项参数均有显著差异（p<0.05）。在准确诊断率、平均隐窝间距离比或任何项目的组织学分级方面，1 个月根除组和>1 个月根除组之间无显著差异。
本研究表明，H. pylori 根除治疗有助于 ME-NBI 中 UD 型 EGC 的准确划定。
