Endoscopic Features of Undifferentiated-Type Early Gastric Cancer in Patients with Helicobacter pylori-Uninfected or-Eradicated Stomachs - Comprehensive Review

Sep 24, 2026

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Comprehensive review of diagnostic demarcation and endoscopic findings in undifferentiated-type early gastric cancers (UD-type EGCs) occurring in Helicobacter pylori-uninfected or eradicated stomachs. Expands rationale for preoperative diagnostic improvement as endoscopic submucosal dissection indications broaden, emphasizing magnifying endoscopy with narrow-band imaging (ME-NBI) and the role of inflammatory cell infiltration in misdiagnosis. Compares white-light and ME-NBI characteristics across groups, noting higher demarcation accuracy after eradication and different lesion morphologies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Introduction

Diagnosis of Demarcation in UD-type EGCs

Gut and Liver [https://doi.org/10.5009/gnl230106](https://doi.org/10.5009/gnl230106)[ ](https://doi.org/10.5009/gnl230106)[pISSN 1976-2283 eISSN 2005-1212](pISSN 1976-2283 eISSN 2005-1212) Review Article | Endoscopic Features of Undifferentiated-Type Early Gastric Cancer in Patients with Helicobacter pylori-Uninfected or-Eradicated Stomachs: A Comprehensive Review
Yusuke Horiuchi, Toshiaki Hirasawa, Junko Fujisaki
Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan | | | | --- | --- | --- | | Article Info
Received March 22, 2023
Revised May 10, 2023
Accepted May 23, 2023
Published online October 19, 2023
Corresponding Author
Yusuke Horiuchi
ORCID [https://orcid.org/0000-0001-8116-8152](https://orcid.org/0000-0001-8116-8152)[ ](https://orcid.org/0000-0001-8116-8152)[E-mail](E-mail yusuke.horiuchi@jfcr.or.jp)[ yusuke.horiuchi@jfcr.or.jp](E-mail yusuke.horiuchi@jfcr.or.jp) | Since the indications for endoscopic submucosal dissection have been expanded to include undifferentiated-type early gastric cancers, improvements in preoperative diagnostic ability have been an area of research. There are also concerns about the impact on the diagnosis of Helicobacter pylori infection. Based on our previous studies, in undifferentiated-type early gastric cancers, magnifying endoscopy with narrow-band imaging is useful for delineating the demarcation regardless of the tumor size. Additionally, inflammatory cell infiltration appears to be a cause of misdiagnosis, suggesting that the resolution of inflammation could contribute to the accurate diagnosis of demarcations. As such, the accuracy of demarcation in eradicated and uninfected cases is higher than that in non-eradicated cases. The common features of the endoscopic findings were discoloration under white-light imaging and a predominance of sites in the lower and middle regions. The uninfected group was characterized by smaller tumor size, flat type, more extended intervening parts in magnifying endoscopy with narrow-band imaging, and pure signet ring cell carcinoma. In contrast, the eradication and non-eradication groups were characterized by larger tumor size, depressed type, and wavy microvessels in magnifying endoscopy with narrow-band imaging. In this comprehensive review, as described above, we discuss the diagnosis of demarcation of undifferentiated-type early gastric cancers, undifferentiated-type early gastric cancers that developed following H. pylori eradication, and H. pylori-uninfected undifferentiatedtype early gastric cancers, with a focus on studies with self-examination and endoscopic findingsand describe the future direction. (Gut Liver 2024;18:209-217)
Key Words: Helicobacter infections; Endoscopic mucosal resection; Stomach neoplasms; Narrow-band imaging; Endoscopy | | |
INTRODUCTION | | tumor diameter increases in UD-type EGCs.15 Accordingly, improvements in the preoperative diagnostic ability are ex- | | In recent years, the indications for endoscopic submu- | | pected. Recently, the usefulness of magnifying endoscopy | | cosal dissection (ESD) have been expanded to include un- | | with narrow-band imaging (ME-NBI) in delineating the | | differentiated-type early gastric cancers (UD-type EGCs; intramucosal, diameter ≤2 cm without ulceration) . 1-4 | | demarcation of differentiated-type EGCs has been reported;16-19 however, its usefulness for UD-type EGC remains | | However, demarcating UD-type EGCs is difficult because | | unclear. | | of the presence of proliferative zone extensions.5,6 The hori- | | Helicobacter pylori is observed in most patients with | | zontal margin-positive rate can range from 1.7% to 52.6%, | | gastric cancer.20,21 Eradication of H. pylori reportedly re- | | and the proportion of curability by ESD can range from | | duces the risk of developing gastric cancer;22 therefore, | | 63.9% to 82.5%; hence, both of these parameters sugges

FAQs

Why is preoperative diagnostic accuracy important for UD-type early gastric cancer?

Indications for endoscopic submucosal dissection have expanded to include UD-type early gastric cancers, making accurate preoperative diagnosis and demarcation essential for appropriate treatment planning.

What endoscopic technique is emphasized for delineating demarcation in UD-type EGCs?

Magnifying endoscopy with narrow-band imaging (ME-NBI) is highlighted as useful for delineating the demarcation of UD-type EGCs regardless of tumor size.

How do endoscopic features differ between H. pylori-uninfected and eradicated groups?

The uninfected group tends to show smaller tumors with flat type findings and more extended intervening parts on ME-NBI, while eradication/non-eradication groups are characterized by larger tumors, depressed type lesions, and wavy microvessels on ME-NBI.

Sep 24, 2026

Uploaded by awa