Yoshiharu Uno

In April 2018, from Hiroshima University, reddish depressed lesions (RDLs) were reported as a specific endoscopic finding of early gastric cancer after eradication of H pylori.

2018年4月、広島大学から、ピロリ菌除菌後に発生する胃癌の所見に関する論文が報告された。

Sanomura Y, Yoshihara M, Tanaka S, Chayama K, et al..

Clinical Significance of Reddish Depressed Lesions Observed in the Gastric Mucosa after Helicobacter pylori Eradication.

Digestion. 2018 Apr 19;98(1):48-55. doi: 10.1159/000487045. [Epub ahead of print]

Abstract

BACKGROUND AND AIM:

Reddish depressed lesions (RDLs) frequently observed in patients following Helicobacter pylori eradication are indistinguishable from gastric cancer. We examined the clinical and histological feature of RDLs and its relevant endoscopic diagnosis including magnifying narrow-band imaging (M-NBI).

METHODS:

We enrolled 301 consecutive patients with H. pylori eradication who underwent endoscopy using white light imaging (WLI). We examined the prevalence and host factors contributing to the presence of RDLs. Next, we used M-NBI in 90 patients (104 RDLs), and compared the diagnostic efficacy between M-NBI and WLI groups using propensity-score matching analysis.

RESULTS:

In 301 patients after eradication, 117 (39%) showed RDLs. Male, open-type atrophy, and gastric cancer history were risk factors for RDLs. A gastric biopsy was needed in 83 (71%) during WLI observation and only 2 were diagnosed with adenocarcinoma. In M-NBI group, a biopsy was performed in 21 (20%), and 9 were diagnosed with adenocarcinoma. A biopsy was required in fewer patients, and the positive predictive value of a biopsy was statistically higher in M-NBI than in the WLI group (p < 0.01).

CONCLUSIONS:

RDLs are frequently observed in high-risk patients for gastric cancer after eradication. M-NBI demonstrated significantly superior diagnostic efficacy with respect to RDL.

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RDL in this study is a lesion not present in conventional H. pylori positive gastric mucosa.

RDL is classified as 'Patchy redness' in Kyoto classification. However, in the Kyoto classification system, 'Patchy redness' recognized only as an ordinary reaction after eradication of pylori.

Therefore, they describe that RDL should be an independent finding.

In other words, in Japan, due to the Kyoto classification system, RDL is recognized only as a common finding after eradication of H. pylori, so many early cancers may be overlooked.

About 1.5 million people are eradicated H. pylori in Japan every year.

RDL occurs in 58.5 thousand of those 39%.

If gastric cancer occurs in 9% of 580,000 people, the number of gastric cancer might be 53,000 per year.

ピロリ菌除菌後に発生する胃癌の所見の特徴として、小さな赤い陥凹が提示された。現在、このような病変は、京都分類では、ピロリ菌除菌後に良くみられる「斑状発赤」に分類されている。そして、そのような病変があっても、通常の粘膜反応所見として、悪性所見とは認識していなかった。しかし、それらの中には、明らかに癌が存在しているという事実は、多くの胃がんが見逃されている危険性を示唆する。
日本では毎年150万人が除菌されているが、今回でデータから計算すると、小さな赤い陥凹病変は、58万人以上に発生し、その9％に胃がんが発生するとすれば、毎年、除菌後の胃癌は5万人以上発生している可能性がある。