ENDOSCOPIC DIAGNOSIS OF HELICOBACTER PYLORI-NEGATIVE GASTRIC CANCER

Abstract

Helicobacter pylori (H. pylori) -negative gastric cancers are divided into H. pylori-uninfected and H. pylori-eradicated types. H. pylori-uninfected cancers are undifferentiated adenocarcinoma and gastric-type differentiated adenocarcinoma (fundic gland type and foveolar epithelial type). Most undifferentiated adenocarcinomas are signet-ring cell, and an endoscopic feature is discolored Type 0-Ⅱc or 0-Ⅱb lesion. Fundic gland-type gastric cancer has a submucosal tumor-like appearance originating from the fundic gland area. Foveolar epithelial-type gastric cancers consist of two types: white flat elevation and raspberry-like protrusion. Most H. pylori-eradicated cancers are well-differentiated Type 0-Ⅱc lesions in patients with severe corpus atrophy. Diagnosis of H. pylori-eradicated cancer is sometimes difficult, as the cancer lesions are often covered with non-neoplastic epithelium. It is important to inform patients that the risk of gastric cancer remains over the long term after H. pylori eradication and to offer them endoscopic surveillance, especially patients with corpus atrophy.