title: Autofluorescence imaging for predicting development of metachronous gastric cancer after Helicobacter pylori eradication.
abstract: OBJECTIVE
  Although Helicobacter pylori eradication decreases the incidence of metachronous gastric cancer after endoscopic treatment for early gastric cancer (EGC), metachronous cancer still develops after successful eradication, particularly in patients with severe corpus gastritis. We investigated whether the extent of atrophic fundic gastritis diagnosed by autofluorescence imaging (AFI) videoendoscopy is predictive of development of metachronous gastric cancer after H. pylori eradication in patients treated with endoscopic submucosal dissection (ESD) for EGC.
  
  
  METHODS
  A total of 82 patients who underwent ESD for EGC from 2003 to 2006, who received eradication therapy participated in this study. The extent of chronic atrophic fundic gastritis was evaluated by AFI and categorized into closed and open type. The main outcome was the incidence of metachronous gastric cancer detected by annual surveillance endoscopy.
  
  
  RESULTS
  During a median observation period of 55 months, metachronous gastric cancer developed in 12 of 82 patients (14.6%). Multivariate Cox's proportional hazard analysis revealed that open-type, atrophic fundic gastritis diagnosed by AFI was significantly associated with development of metachronous gastric cancer (hazard ratio: 4.88, 95% confidence interval [CI]: 1.32-18.2, P = 0.018) after adjustment for age, sex, histological intestinal metaplasia, serum pepsinogen level, and H. pylori status.
  
  
  CONCLUSIONS
  Metachronous EGC developed after successful H. pylori eradication, and extensive atrophic fundic gastritis diagnosed by AFI was a significant predictor, thus it could identify patients undergoing ESD for EGC who still required intensive surveillance after eradication.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Hanaoka
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Akiko
authors.initials: A
authors.lastname: Shiotani
authors.forename: Takuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Koji
authors.initials: K
authors.lastname: Higashino
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tatsuta
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D016009:Chi-Square Distribution; D055088:Early Detection of Cancer; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005453:Fluorescence; D005743:Gastrectomy; D005757:Gastritis, Atrophic / Q000382:microbiology / Q000473:pathology*; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D014741:Video Recording
chemical_list: D000900:Anti-Bacterial Agents