Aims:
To investigate endoscopic NBI appearances of gastric polypoid lesions (GPL).
Methods:
Forty pts (F 55%; median age 63 (36 – 85)yrs) presenting at least one GPL were investigated. Gastroscopies were performed by two experienced endoscopists. GPL images were recorded during gastroscopies and GPL were removed for histological examinations. Both endoscopists independently reviewed digital images in a blinded manner and registered endoscopic NBI appearances on a specific check-list previously elaborated. Endoscopists evaluated the mucosal and vascular pattern and could further indicate other features. Disagreement was resolved by discussion. GPL were then categorized in three different groups (HP, adenomas and T1-GC) using the histological exam as gold standard.
Results:
Overall, 52 GPL were included (29 (55.8%) HP; 18 (34.6%) T1-GC; 5 (9.6%) adenomas). The median size was 7 mm (range 2 – 35). Agreement between endoscopists was 0.92. As shown in Table 1, the presence of a regular circular mucosal pattern was more frequently observed in HP and T1-GC compared to adenomas (p < 0.001). The presence of a central erosion with or without demarcation line was more frequently observed in T1-GC (p < 0.001 vs. HP) and adenomas had a tubule-villous mucosal pattern in 80% (p = 0.01 versus other lesions).
Tab. 1:
n (%); *p < 0.012 versus adenoma; °p = 0.003 versus adenoma; # versus HP and T1-GC p = 0.01; † versus HP p < 0.001
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Hyperplastic polyps n = 29 (55.8)
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Adenomas n = 5 (9.6)
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Type-1 gastric carcinoids n = 18 (34.6)
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Mucosal pattern Regular circular Regular tubulo-villous Irregular
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24 (82.8)* 5 (17.2) 0
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1 (20) 4 (80)# 0
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17 (94.4)° 0 1 (5.6)
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Vascular thickness Normal or thick Thin or ultrathin
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28 (96.6) 1 (3.4)
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5 (100) 0
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17 (94.4) 1 (5.6)
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Other features Central erosion Central erosion + demarcation line
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1 (3.4) 0
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0 0
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8 (44.4)† 6 (33.3)†
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Conclusions:
The NBI analysis of the mucosal pattern seems to be effective to endoscopically discriminate between adenomas and HP while the main characteristic of T1-GC is the presence of a central erosion sometimes with a clear demarcation line. Accordingly, NBI could be an important tool to endoscopically distinguish the histological nature of GPL.
