해외 증례Endoscopic Features of Autoimmune Gastritis: Focus on Typical Images and Early Images

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2022-08-22
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<Image of endoscopic reversed atrophic type gastritis.[1]>









<Pseudo-polyp likey type,  Hyperplastic polyp and Sticky adherent dense mucus.[1]>


<Images of antral mucosa with AIG: (a) normal mucosa; (b) patchy redness; (c)/(d) circular wrinkle‐like pattern (white light image/NBI image.[1]>
<Neuroendocrine tumors (NETs) with AIG.[1]>

<Gastric cancer with AIG.[1]>

<Images of white globe appearance of AIG.[1]>

<Magnifying NBI images of corpus mucosa with AIG. (a)/(b) Foveolar type; (c)/(d) groove type.[1]>

<Cast-off skin appearance (CSA). (a) Marked atrophy of the gastric mucosa is recognized in the lesser curvature of the corpus (white-light image). (b) NBI-magnified image in the black box of (a) shows the CSA that is lacking central pit (gland orifice) in the polygonal vascular network (NBI-magnified image).[2]>

<Two types of micromucosal patterns observed in magnifying narrow-band imaging (upper), and schematic diagram of these structures (lower). The foveola-type mucosa (left) was defined as round, regular crypt-opening (CO) and marginal crypt epithelium (MCE) surrounded by a network of brownish subepithelial capillaries (SEC). The groove-type mucosa (right) was defined as brownish SECs surrounded by ridged MCE.[3]>













<Micromucosal patterns seen in magnifying chromoendoscopy and narrow-band imaging (NBI) in each patient group. Helicobacter pylori (H. pylori)-naïve patient (left): magnifying chromoendoscopy showed round regular crypt-opening (CO). Foveola-type microstructure was seen in magnifying NBI. Images from H. pylori-associated gastritis patient (middle). Groove-type mucosa was seen in the middle of the endoscopic images. Note that the light blue crest sign, which was a representative endoscopic finding of intestinal metaplasia in magnifying NBI, was seen in the groove-type mucosa. Images from autoimmune gastritis patient (right): foveola-type micromucosal pattern was seen in all endoscopic image fields.[3]>


Endoscopic features of early AIG 

<The findings of a case diagnosed as early AIG. It presents a mosaic pattern consisting of swollen gastric areas in the corpus.[1]>


<Endoscopic findings of early AIG in July 2016 (a-d) and in June 2019 (e, f). a: Normal antrum. b: Extensive mucosal atrophy on the lesser curvature of the corpus. c, d: Non-atrophic mucosa on the greater curvature of the corpus in July 2016. e, f: Mild mucosal atrophy and nodules on the greater curvature of the corpus in June 2019.[4]>

<Endoscopic findings of early AIG in December 2017 (a-c) and May 2019 (d). a: Normal antrum. b: Extensive mucosal atrophy on the lesser curvature of the corpus. c: Mild mucosal atrophy and nodules on the greater curvature of the corpus in December 2017. d: Progressive atrophy and reduced number of nodules on the greater curvature of the corpus in May 2019.[4]>


<Endoscopic findings in the patient in early AIG. a) Non-atrophic mucosa and a small hyperplastic polyp were present in the greater curvature of the corpus. b, c) Polygonal areae gastricae surrounded by a reticular border in a mosaic-like pattern were observed. d, e) Endoscopic image of the corpus with 0.2% indigocarmine chromoendoscopy. A mosaic pattern was clearly visible. f) Magnified narrow-band imaging of the corpus. A slightly enlarged, round pit was seen. g) Non-atrophic mucosa, with multiple depressed lines mimicking cracked mucosa, were present on the lesser curvature of the corpus. h) Narrow-band imaging of the lesser curvature. Multiple depressed lines were visible. i) Normal antrum.[5]>

<Endoscopic findings in the patient in early AIG. a, b) Non-atrophic mucosa, with a mosaic pattern, slight swelling of the areae gastricae, and erythema were present in the corpus. c) A mosaic pattern was clearly visible by 0.2% indigocarmine chromoendoscopy. d) Normal antrum.[5]>


<Conventional white-light endoscopic fndings. a The greater curvature side of the corpus. b The lesser curvature side of the corpus. Both the images show difuse reddened and edematous mucosa without remarkable atrophic change.[6]>


<Endoscopic fndings. a Conventional white-light endoscopic fndings of the greater curvature in the middle part of the corpus. b The view of the reddened gastric areas by magnifying endoscopy with narrow-band imaging (ME-NBI). c Conventional white-light endoscopic fndings of the gastric antrum. d ME-NBI fndings of the pyloric gland mucosa. The microvascular pattern of the fundic gland mucosa showed a dilated SECN with regular honeycomb-like arrangement and collecting venules, and the microsurface pattern depicted a regular oval crypt opening and normal oval MCE (a, b). Both conventional white-light and ME-NBI fndings showed that the gastric pyloric gland mucosa was normal (c, d). ME-NBI magnifying endoscopy with narrow-band imaging, SECN subepithelial capillary network, MCE marginal crypt epithelium.[6]>


<a The endoscopic fndings of the greater curvature in the middle part of the corpus 1 year later. There were no changes compared to the previous fndings. The reddened mucosa (black arrow) and the pale mucosa (blue arrow) where the biopsy was performed were shown in this fgure. b, c, d The histopathological fndings in biopsied specimens from the reddened mucosa (left specimen) and from the pale mucosa (right specimen) in the greater curvature in the middle part of the corpus. b HE staining. c Immunostaining for H+ / K+ -ATPase. d Immunostaining for pepsinogen I. The area of lymphocyte infltration accompanied by parietal cell damage was predominantly present in the pale area (b, c, d).[6]>


<The endoscopic image did not show any atrophy, and the mucosa could be considered almost normal.[7]> 


<참고문헌>

1. Maiko Kishino,; Kouichi Nonaka. Endoscopic Features of Autoimmune Gastritis: Focus on Typical Images and Early Images. J Clin Med. 2022 Jun 19;11(12):3523.

2. Kamada, T.; Maruyama, Y.; Monobe, Y.; Haruma, K. Endoscopic features and clinical importance of autoimmune gastritis. Dig. Endosc. 2021, 21, 14175. 

3. Kato, M.; Uedo, N.; Toth, E.; Shichijo, S.; Maekawa, A.; Kanesaka, T.; Takeuchi, Y.; Yamamoto, S.; Higashino, K.; Ishihara, R.; et al. Differences in image-enhanced endoscopic findings between Helicobacter pylori-associated and autoimmune gastritis. Endosc. Int. Open 2021, 9, E22–E30.

4. Kotera, T.; Oe, K.; Kushima, R.; Haruma, K. Multiple Pseudopolyps Presenting as Reddish Nodules Are a Characteristic Endoscopic Finding in Patients with Early-stage Autoimmune Gastritis. Intern. Med. 2020, 59, 2995–3000.

5. Ayaki, M.; Aoki, R.; Mastunaga, T.; Manabe, N.; Fujita, M.; Kamada, T.; Kobara, H.; Masaki, T.; Haruma, K. Endoscopic and Upper Gastrointestinal Barium X-ray Radiography Images of Early-stage Autoimmune Gastritis: A Report of Two Cases. Intern. Med. 2021, 29, 1691–1696.

6.  Kishino, M.; Yao, K.; Hashimoto, H.; Nitta, H.; Kure, R.; Yamamoto, A.; Yamamoto, K.; Nonaka, K.; Nakamura, S.; Tokushige, K. A case of early autoimmune gastritis with characteristic endoscopic findings. Clin. J. Gastroenterol. 2021, 14, 718–724.

7. Kotera, T.; Yamanishi, M.; Kushima, R.; Haruma, K. Early autoimmune gastritis presenting with a normal endoscopic appearance. Clin. J. Gastroenterol. 2022, 15, 547–552. 

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