Enlarged folds on endoscopic gastritis as a predictor for submucosal invasion of gastric cancers

作     者：Osamu Toyoshima Shuntaro Yoshida Toshihiro Nishizawa Akira Toyoshima Kosuke Sakitani Tatsuya Matsuno Tomoharu Yamada Takashi Matsuo Hayato Nakagawa Kazuhiko Koike 

作者机构：Department of GastroenterologyToyoshima Endoscopy ClinicSetagayaku 157-0066TokyoJapan Department of Gastroenterology and HepatologyInternational University of Health and WelfareNarita HospitalNarita 286-8520ChibaJapan Department of Colorectal SurgeryJapanese Red Cross Medical CenterShibuya-ku 150-8935TokyoJapan Department of GastroenterologySakitani Endoscopy ClinicNarashino 275-0026ChibaJapan Department of GastroenterologyGraduate School of MedicineThe University of TokyoBunkyo-ku 113-8655TokyoJapan Department of Internal MedicineSakura Internal Medicine ClinicSetagayaku 157-0071TokyoJapan 

出 版 物：《World Journal of Gastrointestinal Endoscopy》 (世界胃肠内镜杂志（英文版）（电子版）)

年 卷 期：2021年第13卷第9期

页      面：426-436页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Gastric cancer Gastritis Enlarged fold Endoscopy Kyoto classification 

摘      要：BACKGROUND Accurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice.The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins;however,evaluating invasion depth based on endoscopic background gastritis remains unclear.AIM To investigate predicting submucosal invasion using the endoscopy-based Kyoto classification of gastritis.METHODS Patients with gastric cancer detected on esophagogastroduodenoscopy at Toyoshima Endoscopy Clinic were enrolled.We analyzed the effects of patient and tumor characteristics,including age,sex,body mass index,surveillance endoscopy within 2 years,current Helicobacter pylori infection,the Kyoto classification,and Lauren’s tumor type,on submucosal tumor invasion and curative endoscopic resection.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Atrophy was characterized by non-reddish and low mucosa.Intestinal metaplasia was detected as patchy whitish or grayish-white flat elevations,forming an irregular uneven surface.An enlarged fold referred to a fold width≥5 mm in the greater curvature of the corpus.Nodularity was characterized by goosebump-like multiple nodules in the antrum.Diffuse redness was characterized by uniform reddish nonatrophic mucosa in the greater curvature of the corpus.RESULTS A total of 266 gastric cancer patients(mean age,66.7 years;male sex,58.6%;mean body mass index,22.8 kg/m2)were enrolled.Ninety-three patients underwent esophagogastroduodenoscopy for surveillance within 2 years,and 140 had current Helicobacter pylori infection.The mean Kyoto score was 4.54.Fifty-eight cancers were diffuse-type,and 87 cancers had invaded the submucosa.Multivariate analysis revealed that low body mass index(odds ratio 0.88,P=0.02),no surveillance esophagogastroduodenoscopy within 2 years(odds ratio 0.15,P0.001),endoscopic enlarged folds of gastritis(odds ratio 3.39,P=0.001),and Lauren’s diffuse-type(odds ratio 5.09,P0.001)were independently associated with submucosal invasion.Similar results were obtained with curative endoscopic resection.Among cancer patients with enlarged folds,severely enlarged folds(width≥10 mm)were more related to submucosal invasion than mildly enlarged folds(width 5-9 mm,P0.001).CONCLUSION Enlarged folds of gastritis were associated with submucosal invasion.Endoscopic observation of background gastritis as well as the lesion itself may help diagnose the depth of cancer invasion.