Autoimmune gastritis (AIG) is considered to be a premalignant condition and associated with an increased risk of gastric neoplasia. Endoscopic diagnosis is usually difficult, and most cases are overlooked and therefore the identification of specific endoscopic markers is important for the accurate diagnosis of AIG. During magnifying image-enhanced endoscopy (M-IEE) of the gastric corpus mucosa in patients with AIG, we noted the presence of multiple minute round-shaped pale* “glomus-like” lesions (GLLs) with branched microvessels. It had not been described in the literature before. In the present study, we investigated the nature and the diagnostic utility of GLLs for the AIG diagnosis

57 patients with AIG (including 22 patients with gastric neuroendocrine neoplasia (NEN) type 1) and 54 age- and sex-matched patients with H.pylori-induced multifocal atrophic gastritis (MAG) were enrolled in this study. After white light imaging (WLI) observation M-IEE (NBI, BLI, Iscan-OE) of the gastric corpus mucosa was performed. Biopsy was taken from a gastric mucosa with and without GLLs for histological evaluation.

GLLs were found in 44 out of 57 (77%) patients with AIG, (in22 out of 22 (100%) patients with NEN) and in 0 out of 54 (0%) patients with MAG (P=0.0001). For AIG diagnosis by GLLs sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) were 0.77, 1.00, 0.88, 1.00, 0.81, respectively. All biopsy specimens taken from GLLs revealed mucosal atrophy, enterochromaffin-like (ECL) cell hyperplasia, cysts of foveolar epithelium

The presence of GLLs was associated with histological features of atrophy in patients with AIG and were found in every case of NEN. GLLs could be considered as an endoscopic marker of advanced atrophy in patient with AIG who has an increased risk of NEN development. This novel indicator was found to be a highly specific feature of AIG and could be used in clinical practice.