Map-like redness is a known gastric mucosal finding observed after Helicobacter pylori eradication. Recently, we identified gastric lesions resembling barnacles and observed that they appear more commonly in cases of post-H. pylori infection. This study aimed to investigate clinicopathological characteristics of these barnacle-like lesions.

We analyzed clinical characteristics in 436 consecutive patients examined at Kawasaki Medical School General Medical Center. Histopathological examination was conducted in 43 patients, with 65 biopsies taken from barnacle-like lesions and 17 from the surrounding mucosa. The 43 patients comprised 20 patients biopsied at General Medical Center and 23 patients at Junpukai.

In total, 413 patients (208 women) were included in the analysis after excluding 23 patients based on exclusion criteria. Barnacle-like lesions were identified in 66 patients (16.0%), most frequently around the gastric angle, and were significantly more common in patients with mild atrophy of the fundic mucosa. Of the 66 patients with barnacle-like lesions, 65 were considered to have a post-H. pylori infection status and one was currently infected. Histopathological examination revealed intestinal metaplasia in 54 (83.1%) of the 65 biopsies from barnacle-like lesions. By contrast, all 17 biopsies from surrounding mucosa showed normal fundic mucosa without inflammation or atrophy.

Barnacle-like lesions are a characteristic endoscopic finding of gastric mucosa post-infected with H. pylori and are histopathologically consistent with intestinal metaplasia.

Received: 18 November 2024

Accepted after revision: 26 June 2025

Accepted Manuscript online:
30 June 2025

Article published online:
29 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Bibliographical Record
Aya Sunago, Takahisa Murao, Ken Haruma, Maki Ayaki, Noriaki Manabe, Minoru Fujita, Takashi Akiyama, Mitsuhiko Suehiro, Hirofumi Kawamoto, Kazuhiko Inoue, Katsuhiro Mabe, Eiichiro Kanda, Tomoari Kamada. Barnacle-like lesions in the gastric mucosa: Clinicopathological study of a novel endoscopic finding. Endosc Int Open 2025; 13: a26457506.
DOI: 10.1055/a-2645-7506