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Kazuhiro Mizukami [] and Ryo Ogawa [] and Kazuhisa Okamoto [] and Mitsutaka Shuto [] and Kensuke Fukuda [] and Akira Sonoda [] and Osamu Matsunari [] and Yuka Hirashita [] and Tadayoshi Okimoto [] and Masaaki Kodama [] and Kazunari Murakami [] and []

Academic Editor: Tatsuya Toyokawa

Department of Gastroenterology, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan, oita-u.ac.jp

Received Jun 1, 2017; Revised Aug 18, 2017; Accepted Sep 19, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Since the discovery of Helicobacter pylori (H. pylori) [1], chronic gastritis has attracted attention not only for its symptoms but also as a precursor lesion for gastric cancer. At present, the endoscopic diagnosis of chronic gastritis is one of the most important findings with careful consideration.

Typical endoscopic findings of H. pylori-infected gastric mucosa include atrophy, diffuse redness, hyperplastic polyps, gastric xanthoma, intestinal metaplasia, enlarged folds, and nodularity [2–6]. Among these findings, atrophy [7, 8], nodular gastritis [9], and enlarged folds [4] are reported to be associated with gastric cancer. Particularly, the progression of atrophy has been noted to correlate with the risk of developing gastric cancer. Masuyama et al. reported that cancer incidence was higher among patients with advanced gastric mucosal atrophy, and most patients with synchronous or metachronous cancer presented with particularly severe atrophy [10]. Thus, accurate evaluation of the degree of atrophy is expected to enable prediction of not only current but also future development of cancer.

Endoscopic mucosal atrophy is diagnosed based on findings such as loss of folds, discoloration, and enhanced visibility of the vascular pattern, while the progression of mucosal atrophy is classified according to the extent of mucosal involvement [11]. When the border of the lesion is clearly distinguishable in terms of color (e.g., atrophic and nonatrophic mucosae have a different color), it is easy to determine the extent of atrophy. However, when the border is ambiguous in color, it may be difficult to detect atrophy or determine its extent.

Linked color imaging (LCI) (Fujifilm Co., Tokyo, Japan) is a recently developed image-enhanced endoscopy system that emphasizes differences in...

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