Seiichiro Abe, Shih Yea Sylvia Wu, Mai Ego, Hiroyuki Takamaru, Masau Sekiguchi, Masayoshi Yamada, Satoru Nonaka, Taku Sakamoto, Haruhisa Suzuki, Shigetaka Yoshinaga, Takahisa Matsuda, Ichiro Oda, and Yutaka Saito. Gut and Liver 1999;0:. https://doi.org/10.5009/gnl19266

Background: Precision cancer risk stratification for gastric cancer is urgently needed for the growing number of healthy people after Helicobacter pylori eradication. The epimutation burden in non-malignant tissues has been associated with cancer risk in multiple cross-sectional studies. Objective: To confirm the clinical usefulness of a DNA methylation marker for epimutation burden, and to identify a cut-off methylation level for a super-high-risk population. Design: Healthy people after H. pylori eradication with open-type atrophy were prospectively recruited. DNA methylation levels of a marker gene, RIMS1 , were measured in biopsy specimens from gastric antrum and body. The primary endpoint was the incidence rate of gastric cancer in quartiles of the methylation levels. Results: 1624 participants had at least one endoscopic follow-up with a median follow-up of 4.05 years, and a primary gastric cancer developed in 27 participants. The highest quartile of RIMS1 methylation levels had a higher incidence rate (972.8 per 100 000 person-years) than the lowest quartile (127.1). Cox regression analysis revealed a univariate HR of 7.7 (95% CI 1.8–33.7) and an age- and sex-adjusted HR of 5.7 (95% CI 1.3–25.5). As a secondary objective, a cut-off methylation level of 25.7% (95% CI 1.7–7.7) was obtained to identify a population with a super-high risk based on the number needed to screen of 1000. Conclusion: A DNA methylation marker can risk-stratify healthy people after H. pylori eradication even though all of them have clinically high risk. Individuals with super-high risk will need more frequent gastric cancer screening than currently recommended. Trial registration number: UMIN-CTR000016894.

Objectives: We aimed to evaluate the efficacy of texture and color enhancement imaging (TXI), which allows the acquisition of brighter images with enhanced color and surface structure in colorectal polyp detection compared to white light imaging.Methods: Patients who underwent colonoscopy with repeated ascending colon observation using TXI and white light imaging between August 2020 and January 2021 were identified in three institutions. The outcomes included the mean number of adenomas detected per procedure (MAP), adenoma detection rate (ADR), and ascending colonic adenoma miss rate (Ac‐AMR). Logistic regression was used to determine the effects of the variables on the outcomes.Results: We included 1043 lesions from 470 patients in the analysis. The MAP, ADR, flat polyp detection rate, and Ac‐AMR in TXI and white light imaging were 1.5% (95% confidence interval 1.3–1.6%) vs. 1.0% (0.9–1.1%), 58.2% (51.7–64.6%) vs. 46.8% (40.2–53.4%), 66.2% (59.8–72.2%) vs. 49.8% (43.2–56.4%), and 17.9% (12.1–25.2%) vs. 28.2% (20.0–37.6%), respectively. TXI, age, withdrawal time, and endoscopy type were identified as significant factors affecting the MAP and the ADR using multivariate regression analysis.Conclusions: Our study indicates that TXI improve the detection of colorectal neoplastic lesions. However, prospective randomized trials are required to confirm these findings.