title: Endoscopic features associated with development of metachronous gastric cancer in patients who underwent endoscopic resection followed by Helicobacter pylori eradication.
abstract: The preventive effect of Helicobacter pylori (HP) eradication on metachronous gastric cancer development after endoscopic resection remains controversial. The aim of this study was to identify specific endoscopic features that correlated with the risk of metachronous gastric cancer development after endoscopic submucosal dissection (ESD) using both endoscopic findings before ESD and changes of findings after HP eradication.
  
  
  
  This retrospective study investigated 122 consecutive patients who underwent ESD for early gastric cancer and successful HP eradication after ESD. Endoscopic findings linked with HP before ESD and changes after HP eradication were evaluated according to the development of metachronous cancer.
  
  
  
  Most patients showed severe atrophy and intestinal metaplasia (IM) before ESD (97% and 83%, respectively). Improvement of spotty redness, improvement of diffuse redness, emergence of patchy redness, and emergence of map-like redness were frequent findings after HP eradication (52%, 50%, 54%, and 32%, respectively). Kaplan-Meier curves indicated that patients without IM before ESD never developed metachronous cancer, while patients with emergence of map-like redness after HP eradication were significantly more likely to develop metachronous cancer (log-rank test, p = 0.031 and p < 0.001, respectively). Multivariate analysis indicated that emergence of map-like redness after HP eradication was the only predictive factor for development of metachronous cancer (hazard ratio, 3.61; 95% confidence interval, 1.41-9.21; p = 0.007).
  
  
  
  Absence of IM before ESD and emergence of map-like redness after HP eradication were useful endoscopic findings in the negative and positive prediction of metachronous gastric cancer developing after ESD.
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Moribata
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Jun Kato1 Mikitaka
authors.initials: JK
authors.lastname: Iguchi
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Nakachi
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Shingaki
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Niwa
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Deguchi
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Inoue
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, 641-0012, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
keywords: eradication; gastric cancer; intestinal metaplasia; map-like redness