Failure of Helicobacter pylori eradication and age are independent risk factors for recurrent neoplasia after endoscopic resection of early gastric cancer in 283 patients.
BACKGROUND
Whether the incidence of metachronous gastric dysplasia and cancer could be decreased by eradication of Helicobacter pylori after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).


OBJECTIVE
To compare the incidence of metachronous gastric lesion in the eradicated group and the persistent group. Second end point is to evaluate the risk factors for metachronous gastric lesions after ESD for EGC.


METHODS
In a single centre, between May 2007 and May 2010, the patients who had evidence of H. pylori infection at the time of ESD for EGC were included, and the follow-up data were analysed retrospectively.


RESULTS
We enrolled 283 patients who have shown H. pylori infection at the time of ESD for EGC. Successful eradication was achieved for 214 patients (75.6%) (Eradicated group), and 69 patients (24.4%) showed persistent H. pylori infection (Persistent group). Metachronous gastric lesions developed in 13 (18.8%) in the persistent group and 18 (8.4%) in the eradicated group (P = 0.016). In the ≥60-year-old group, the cumulative incidence of metachronous gastric cancer showed a significant increase (P = 0.012). Cumulative hazard ratio of subsequent gastric metachronous lesions differed between the eradication group and the persistent infection group (OR = 2.322, 95% CI = 1.136-4.744, P = 0.021), and ≥60 age at the time of endoscopic resection (OR = 2.803, 95% CI = 1.207-6.509, P = 0.016).


CONCLUSIONS
Both persistent H. pylori infection and old age (≥60) are independent risk factors for the increased incidence of metachronous gastric cancer.
Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, South Korea.
Y H
YH
Kwon
J
J
Heo
H S
HS
Lee
C M
CM
Cho
S W
SW
Jeon
D000367:Age Factors; D000368:Aged; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy / Q000009:adverse effects; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery