Comparision of high resolution magnifying endoscopy and standard videoendoscopy for the diagnosis of helicobacter pylori gastritis

Helicobacter pylori (H.pylori) is the primary cause of chronic gastritis. Studies investigating the relationship between standard videoendoscopic features and histopathologic findings of gastritis reported poor correlation. The purpose of this study was to compare standard videoendoscopy with high resolution magnifying endoscopy for the diagnosis of H.pylori gastritis and to determine whether histopathologic gastritis can be diagnosed based on findings at high resolution endoscopy. A total of 129 patients were enrolled into the study. Erythema, erosions, prominent area gastrica and nodularity investigated by standard endoscopy. After standard videoendoscopy, greater and lesser curvatures of corpus were studied by high resolution for mucosal microvascularity (regular, obscure or irregular collecting venulae) and microstructure. Greater and lesser curvatures of antrum were studied for well- or ill-defined mucosal pattern. Additionally, chromoendoscopy with indigocarmine staining performed in 55 patients. The sites observed by high resolution were assessed histopathologically. The sensitivity and specificity of impaired microarchitecture for corporal H.pylori gastritis were 93.9% and 90.3%, respectively. No standard endoscopic features showed a sensitivity of more than 44.7% for corporal gastritis. Considering the antrum, the sensitivity and specificity of ill-defined mucosal pattern for gastritis were 89.3% and 65.2%, respectively. Sensitivity of antral erythema and erosions by standard videoendoscopic examination were 69.9% and 21.4%. Indigocarmen staining has a marginal additional diagnostic efficacy. Specific pathologic features such as atrophy and intestinal metaplasia accumulate in particular microarchitectural patterns. High resolution magnifying endoscopy is superior to standard videoendoscopy for the diagnosis of H.pylori gastritis and identification of specific histopathologic features can be possible. Keywords: high resolution endoscopy, helicobacter pylori, chromoendoscopy, indigocarmine