Clinical and endoscopic characteristics of early gastric signet ring cell carcinoma based on Helicobacter pylori infection status

BACKGROUND Early gastric signet ring cell carcinoma (eGSRCC) is a distinct histological subtype of gastric cancer with unique biological behaviors. However, the impact of Helicobacter pylori (H. pylori ) infection status on the clinical and endoscopic characteristics of endoscopically resectable eGSRCC remains uncertain. AIM To evaluate clinical and endoscopic characteristics of eGSRCC based on H. pylori status and to assess its implications for endoscopic management. METHODS We retrospectively analyzed consecutive patients with histologically confirmed eGSRCC at Shenzhen People’s Hospital between January 2020 and December 2024. Patients were stratified into three groups: H. pylori -positive, H. pylori -eradicated and H. pylori -uninfected. Detailed clinical and endoscopic data were compared. RESULTS A total of 29 patients were included, with 12 (41.4%) in the H. pylori -positive group, 7 (24.1%) in the H. pylori -eradicated group, and 10 (34.5%) in the H. pylori -uninfected group. Significant differences in endoscopic features were observed based on H. pylori status; 88.9% of the lesions were located at the lower third of gastric body and 80% presented as type 0-IIb with whitish discoloration in H. pylori- uninfected group. In contrast, more lesions in H. pylori -positive group manifested 0-IIc type with reddish roughness with or without spontaneous bleeding. Notably, all three cases of delayed post-endoscopic submucosal dissection (ESD) bleeding occurred exclusively in the H. pylori -positive group. All the cases achieved en bloc resection with no recurrence. CONCLUSION H. pylori infection status significantly impacts the clinical and endoscopic presentations of eGSRCC. Recognizing the differences aids early detection and H. pylori eradication prior to ESD optimizes endoscopic management.