White globe appearance is an endoscopic predictive factor for synchronous multiple gastric cancer

• Published in: Annals of gastroenterology Vol. 34; no. 2; pp. 183 - 187
• Main Authors: Masunaga, Teppei, Yoshida, Naohiro, Akiyama, Shinichiro, Sugiyama, Gen, Hirai, Hirokazu, Miyajima, Saori, Wakita, Shigenori, Kito, Yosuke, Nakanishi, Hiroyoshi, Tsuji, Kunihiro, Matsunaga, Kazuhiro, Tsuji, Shigetsugu, Takemura, Kenichi, Katayanagi, Kazuyoshi, Minato, Hiroshi, Doyama, Hisashi
• Format: Journal Article
• Language: English
• Published: Greece Hellenic Society of Gastroenterology 01.01.2021
• Subjects: Original; endoscopic submucosal dissection; White globe appearance; synchronous multiple gastric cancer; gastric cancer
• ISSN: 1108-7471; 1792-7463; 1792-7463
• DOI: 10.20524/aog.2020.0565

White globe appearance (WGA) is a small white lesion with a globular shape identified during magnifying endoscopy with narrow-band imaging. However, the association between WGA and synchronous multiple gastric cancer (SMGC) remains unclear. Consecutive patients who underwent endoscopic submucosal dissection for gastric cancer (GC) between July 2013 and April 2015 at our institution were eligible for this study. We excluded patients with a history of gastric tumor or gastrectomy. Patients who had more than 2 GCs in their postoperative pathological evaluation were classified as SMGC-positive, and patients who had at least 1 WGA-positive GC were classified as WGA-positive patients. The primary outcome was a comparison of the prevalence of WGA in patients classified as SMGC-positive and SMGC-negative. Univariate and multivariate analyses were performed using the following variables: WGA, age, sex, atrophy, and ( ) status. There were 26 and 181 patients classified as SMGC-positive and SMGC-negative, respectively. Univariate analysis revealed that WGA-positive classification (50% vs. 23%, P=0.008) and male sex (88% vs. 66%, P=0.02) were significant factors associated with SMGC classification, while age ≥65 years (81% vs. 81%, P>0.99), severe atrophy (46% vs. 46%, P>0.99), and positivity (69% vs. 65%, P=0.8) were not. In the multivariate analysis, only WGA-positive classification (odds ratio 2.78, 95% confidence interval 1.16-6.67; P=0.02) was a significant independent risk factor for SMGC. Our exploratory study showed the possibility of WGA as a predictive factor for SMGC. In cases of WGA-positive gastric cancer, careful examination might be needed to diagnose SMGC.