title: Influence of endoscopic submucosal dissection on serum levels of pepsinogens in patients with early gastric cancer.
abstract: BACKGROUND
  The serum levels of pepsinogens (PG) have been considered to be a useful marker for assessing the risk of metachronous gastric cancer in patients who undergo endoscopic submucosal dissection. However, the influence of endoscopic submucosal dissection (ESD) on serum levels of PG has not yet been examined. The aim of this study was to examine whether the level of PG after ESD can be used to predict the risk of metachronous cancer.
  
  
  METHODS
  The study included of 100 consecutive patients who underwent ESD for gastric cancer at Hirosaki University Hospital from September 2009 to February 2011. Serum levels of PG I and II on the day before and after ESD were compared. Stool antigen test was also performed to examine the presence of Helicobacter pylori infection.
  
  
  RESULTS
  The mean serum level of PG I before and after ESD was 34.3 ± 31.6 ng/mL and 70.5 ± 100.0 ng/mL (P < 0.001), respectively. PG I/II ratio before and after ESD was 2.40 ± 1.51 and 2.79 ± 1.70 (P < 0.001). The serum level of PG I and the PG I/II ratio were significantly changed after ESD, regardless of the use of proton pump inhibitor, Helicobacter pylori infection or the location of the tumor.
  
  
  CONCLUSIONS
  ESD treatment modulates the serum level of PG I and significantly increases the PG I/II ratio. Serum levels of PG should be measured before the ESD procedure is performed to predict the risk of developing metachronous gastric cancer after ESD.
authors.affiliation: Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Iino
authors.forename: Tadashi
authors.initials: T
authors.lastname: Shimoyama
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Sawaya
authors.forename: Norihiro
authors.initials: N
authors.lastname: Hanabata
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D004210:Dissection / Q000379:methods*; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010435:Pepsinogens / Q000097:blood*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D010435:Pepsinogens