Regular arrangement of collecting venules as a predictor of Helicobacter pylori absence using white-light endoscopy: a multicenter prospective study outside Asia.
Rodrigo Garcés-Duran, Joan Llach, Pedro Delgado-Guillena, Riccardo Vasapolli, Gertjan Rasschaert, Liv Vandermeulen, Jan Bornschein, Pierre H Deprez, Masa Cavlina Sevo, Stefano Realdon, Ivan Lyutakov, Alanna Ebigbo, Innocent Francis, Romanas Zykus, Tadas Urbonas, Stefania Maiero, Mirjana Kalauz, Henry Córdova, Leticia Moreira, Gloria Fernández-Esparrach
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Abstract
Background and aims: Endoscopic assessment of the regular arrangement of collecting venules (RAC) is a simple and reliable tool for predicting the absence of Helicobacter pylori (H. pylori) infection in the stomach, particularly in Asian populations. While initial studies in Western countries have yielded similar findings, RAC assessment has not yet been widely adopted in these settings. This study aims to evaluate the diagnostic accuracy of RAC in determining H. pylori status in a non-Asian population.
Methods: This prospective, multicenter study was conducted in 12 hospitals across non-Asian countries. Patients with no history of H. pylori infection or eradication were included, regardless of proton pump inhibitor (PPI) use. All participants underwent high-definition upper endoscopy without magnification or virtual chromoendoscopy. Endoscopists were trained using a 20-image test to identify the RAC pattern. H. pylori status was determined by histology and/or immunohistochemistry.
Results: A total of 648 patients were included, with an H. pylori infection prevalence of 34.7%. The RAC+ pattern was observed in 31.5% of patients, with no significant differences between those receiving PPI treatment and those who were not (p = 0.55). Absence of pathological endoscopic findings was significantly associated with a RAC+ pattern (p = 0.01). The sensitivity and negative predictive value (NPV) of RAC+ for ruling out H. pylori infection were 0.97 (95% CI: 0.94-0.99), reaching 1.00 when discordant images were reviewed by a blinded expert endoscopist. No significant differences in sensitivity or NPV were found between PPI users and non-users, or between regions with high and low H. pylori prevalence.
Conclusion: The presence of the RAC pattern along the minor gastric curvature, as assessed with white-light endoscopy, accurately identifies patients without H. pylori infection in non-Asian countries, regardless of PPI use.
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