pylori status (adjusted hazard ratio 4.88, 95% confidence interval [CI] 1.32–18.2, P = 0.018, Table 3). When we reduced the covariates to age and intestinal metaplasia in the lesser curvature of the corpus, which were significant predictors by univariate analysis, the independent significance of open-type, atrophic fundic gastritis, demonstrated by AFI, remained. In the present study, we found that a considerable number of metachronous EGCs developed in patients
who received ESD for EGC after successful eradication of H. pylori. This shows that early recognition and management of multiple EGCs is one of the keys to obtaining good prognosis after treatment of EGC with ESD. Moreover, a wide area of atrophic fundic gastritis diagnosed by AFI was an independent predictor for development of metachronous EGC. Our previous selleck chemical study has shown that atrophy in biopsy specimens of the lesser curvature of the corpus is associated strongly with gastric cancer risk.11 In the current study, intestinal metaplasia at the lesser curvature of the corpus was associated with development of metachronous EGC, by univariate RXDX-106 solubility dmso analysis; however, it was not statistically significant in multivariate analysis after adjusting for the extent of atrophic fundic gastritis
diagnosed by AFI. Biopsy evaluates only a narrow area in the whole gastric mucosa, therefore it cannot evaluate the actual extent or distribution of the gastric mucosal changes related to gastric carcinogenesis, such as mucosal atrophy or intestinal metaplasia, and it might cause sampling error. This suggests that the evaluation of gastritis by endoscopy is more suitable for the assessment of risk of development of metachronous EGC compared with point evaluation by biopsy. To diagnose the extent of chronic atrophic fundic gastritis by endoscopy, we have developed the endoscopic Congo red test and have demonstrated that the 上海皓元医药股份有限公司 method can
identify patients at high risk for development of gastric cancer, in a long-term cohort study.16,17 However, the endoscopic Congo red test requires gastrin injection to stimulate acid secretion, dye spraying over the entire gastric mucosa, and observation of the color change in the Congo red dye for several minutes. Therefore, it has not been used widely in clinical practice because of its complicated and time-consuming procedure, and potential adverse effects of drug or dye administration. AFI is a new endoscopic imaging technology that uses illumination of different wavelength light through a filter in a light source, and it can be performed subsequently to white light endoscopy by simply pressing a small button on the videoendoscope. The method demands neither drug injection nor dye spraying.