Clin Endosc.  2018 Nov;51(6):558-562. 10.5946/ce.2018.104.

Magnified Endoscopic Findings of Multiple White Flat Lesions: A New Subtype of Gastric Hyperplastic Polyps in the Stomach

• Hasegawa R
• Yao K
• Ihara S
• Miyaoka M
• Kanemitsu
• Chuman K
• Ikezono G
• Hirano A
• Ueki T
• Tanabe H
• Ota A
• Haraoka S
• Iwashita A

• KMID: 2430398
• DOI: http://doi.org/10.5946/ce.2018.104

Abstract

BACKGROUND/AIMS
: While the occurrence of multiple whitish flat elevated lesions (MWFL) was first reported in 2007, no studies on MWFL have been published to date. The present retrospective observational study aimed to clarify the endoscopic findings and clinicopathological features of MWFL.
METHODS
: Subjects were consecutive patients who underwent upper gastrointestinal endoscopy as part of routine screening between April 2014 and March 2015. The conventional white-light, non-magnifying and magnifying narrow-band images were reviewed. Clinical features were compared between patients with and without MWFL.
RESULTS
: The conventional endoscopic findings of MWFL include multiple whitish, flat, and slightly elevated lesions of various sizes, mainly located in the gastric body and fundus. Narrow-band imaging enhanced the contrast of MWFL and background mucosa, and magnifying narrow-band imaging depicted a uniformly long, narrow, and elliptical marginal crypt epithelium with an unclear microvascular pattern. Histopathological findings revealed hyperplastic changes of the foveolar epithelium, and parietal cell protrusions and oxyntic gland dilatations were observed in the fundic glands, without any intestinal metaplasia. The rate of acid-reducing drug use was significantly higher in patients with MWFL than in those without (100% [13/13] vs. 53.7% [88/164], p < 0.001).
CONCLUSIONS
: The present study indicated a relationship between the presence and endoscopic features of MWFL and history of acidreducing drug use.

Keyword

Multiple white flat lesions; Proton pump inhibitor; Stomach; Polyp; Magnified endoscopy findings

MeSH Terms

Dilatation
Endoscopy, Gastrointestinal
Epithelium
Humans
Mass Screening
Metaplasia
Mucous Membrane
Observational Study
Polyps*
Rabeprazole
Retrospective Studies
Stomach*

Figure

• 

  Fig. 1. Endoscopic findings of multiple whitish flat elevated lesions. (A) Conventional white-light imaging. Multiple whitish, flat, slightly elevated lesions of various sizes can be seen in the gastric fundus. (B) Non-magnifying narrow-band imaging. The background mucosa appears dark brownish, increasing the contrast with the white lesions and making them easier to visualize. (C) Magnifying narrow-band imaging. Clear demarcation lines can be observed. The superficial microvascular pattern is not clearly visualized. In terms of microsurface patterns, the marginal crypt epithelium is large, increasing slightly and presenting a faint dark brown color in the intervening part between crypts.

• 

  Fig. 2. Histopathological findings of biopsy specimen (hematoxylin and eosin staining). (A) Hyperplastic changes can be seen in the foveolar epithelium. (B) Parietal cell protrusions and oxyntic gland dilatations can be seen.

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