Abstract
BACKGROUND: In the revised Japanese guidelines for gastric cancer screening published in 2014, population-based and opportunistic endoscopic and radiographic screening were both recommended. Advances in esophagogastroduodenoscopy have enabled detection of minimal changes in the gastric mucosa due to early stage cancer, but opaque gastric mucus covering the surface of gastric lesions hampers detailed observation of microlesions. We reported a novel, simple pretreatment with pronase to remove this opaque mucus and improve endoscopic observation of the gastric mucosa. In this study, we explored the usefulness of this pretreatment in clinical cases of gastritis.
METHODS: We randomly assigned 609 subjects to receive pronase pretreatment (404 subjects) or no pretreatment (205 subjects). The subjects were not taking proton pump inhibitors or H2-receptor antagonists and had no history of gastrectomy. The degree of opacity of mucus was compared between the two groups.
RESULTS: The opacity of mucus, which was copious in chronic gastritis compared to that in normal or superficial gastritis, was decreased by pretreatment with pronase. The opacity of mucus was higher in Helicobacter pylori-positive subjects. The difference between groups was significant with pronase pretreatment.
CONCLUSIONS: The degree of opacity of mucus was high in patients with chronic gastritis and H. pylori-positive gastritis and hampered detailed observation of microlesions. A novel, simple pretreatment with pronase to remove this opaque mucus was considered effective for enabling detailed observation of lesions, including early gastric cancer.
