Background and Aim:Helicobacter pylori is the leading cause of gastric cancer, but it is still uncertain whether eradicating H. pylori in early gastric cancer (EGC) patients who underwent endoscopic resection can prevent metachronous gastric cancer (MGC). This study aimed to investigate the effect of H. pylori eradication to prevent MGC after endoscopic submucosal dissection (ESD). Methods: In this propensity-matched retrospective observational study, 770 patients with EGC who received ESD were enrolled. The outcome was the incidence of MGC; this was compared between the persistent and eradicated groups. Results: MGC was detected in 27 patients (7.8%) during a median period of 39.0 months (range 26.0–64.0). After propensity matching, 126 pairs of patients in each group were analyzed. The 5-year cumulative incidence rates of MGC were 13.2 and 3.9% in the persistent and eradicated groups, respectively (p= 0.021, log-rank test). On multivariate analysis, H. pylori eradication prevented MGC significantly (hazard ratio [HR] 0.32; p = 0.029). The results remained robust after inverse probability of treatment weighting analysis (HR 0.30; p = 0.020). Conclusions: Successful H. pylori eradication could prevent MGC after ESD for EGC.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394–424.
Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10(1):1–11.
Hasuike N, Ono H, Boku N, Mizusawa J, Takizawa K, Fukuda H, et al.; Gastrointestinal Endoscopy Group of Japan Clinical Oncology Group (JCOG-GIESG). A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a): the Japan Clinical Oncology Group study (JCOG0607). Gastric Cancer. 2018 Jan;21(1):114–23.
Fukunaga S, Nagami Y, Shiba M, Ominami M, Tanigawa T, Yamagami H, et al. Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis. Gastrointest Endosc. 2017 Jan;85(1):143–52.
Pyo JH, Lee H, Min BH, Lee JH, Choi MG, Lee JH, et al. Long-term outcome of endoscopic resection vs. surgery for early gastric cancer: A non-inferiority-matched cohort study. Am J Gastroenterol. 2016 Feb;111(2):240–9.
Wong BC, Lam SK, Wong WM, Chen JS, Zheng TT, Feng RE, et al.; China Gastric Cancer Study Group. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA. 2004 Jan;291(2):187–94.
Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon AT, Bazzoli F, et al.; ­European Helicobacter Study Group. Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report. Gut. 2012 May;61(5):646–64.
Japanese Gastric Cancer Association. ­Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017 Jan;20(1):1–19.
Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, et al.; Japan Gast Study Group. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet. 2008 Aug;372(9636):392–7.
Maehata Y, Nakamura S, Fujisawa K, Esaki M, Moriyama T, Asano K, et al. Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer. Gastrointest Endosc. 2012 Jan;75(1):39–46.
Choi J, Kim SG, Yoon H, Im JP, Kim JS, Kim WH, et al. Eradication of Helicobacter pylori after endoscopic resection of gastric tumors does not reduce incidence of metachronous gastric carcinoma. Clin Gastroenterol Hepatol. 2014 May;12(5):793–800.e1.
Choi IJ, Kook MC, Kim YI, Cho SJ, Lee JY, Kim CG, et al. Helicobacter pylori Therapy for the Prevention of Metachronous Gastric Cancer. N Engl J Med. 2018 Mar;378(12):1085–95.
Choi JM, Kim SG, Choi J, Park JY, Oh S, Yang HJ, et al. Effects of Helicobacter pylori eradication for metachronous gastric cancer prevention: a randomized controlled trial. Gastrointest Endosc. 2018 Sep;88(3):475–485.e2.
Kubo S, Nakayamada S, Nakano K, Hirata S, Fukuyo S, Miyagawa I, et al. Comparison of the efficacies of abatacept and tocilizumab in patients with rheumatoid arthritis by propensity score matching. Ann Rheum Dis. 2016 Jul;75(7):1321–7.
D’Agostino RB Jr, D’Agostino RB Sr. Estimating treatment effects using observational data. JAMA. 2007 Jan;297(3):314–6.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011 Jun;14(2):101–12.
Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;1(03):87–97.
Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41–55.
Nagami Y, Tominaga K, Machida H, Nakatani M, Kameda N, Sugimori S, et al. Usefulness of non-magnifying narrow-band imaging in screening of early esophageal squamous cell carcinoma: a prospective comparative study using propensity score matching. Am J Gastroenterol. 2014 Jun;109(6):845–54.
Watanabe T, Tanigawa T, Shiba M, Nadatani Y, Nagami Y, Sugimori S, et al. Anti-tumour necrosis factor agents reduce non-steroidal anti-inflammatory drug-induced small bowel injury in rheumatoid arthritis patients. Gut. 2014 Mar;63(3):409–14.
Xie J, Liu C. Adjusted Kaplan-Meier estimator and log-rank test with inverse probability of treatment weighting for survival data. Stat Med. 2005 Oct;24(20):3089–110.
Grool AM, Aglipay M, Momoli F, Meehan WP 3rd, Freedman SB, Yeates KO, et al.; ­Pediatric Emergency Research Canada (PERC) Concussion Team. Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents. JAMA. 2016 Dec;316(23):2504–14.
Lee YC, Chiang TH, Chou CK, Tu YK, Liao WC, Wu MS, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: A systematic review and meta-analysis. Gastroenterology. 2016 May;150(5):1113–1124.e5.
Jung DH, Kim JH, Chung HS, Park JC, Shin SK, Lee SK, et al. Helicobacter pylori eradication on the prevention of metachronous lesions after endoscopic resection of gastric neoplasm: A Meta-Analysis. PLoS One. 2015 Apr;10(4):e0124725.
Bae SE, Jung HY, Kang J, Park YS, Baek S, Jung JH, et al. Effect of Helicobacter pylori eradication on metachronous recurrence after endoscopic resection of gastric neoplasm. Am J Gastroenterol. 2014 Jan;109(1):60–7.
Kim YI, Choi IJ, Kook MC, Cho SJ, Lee JY, Kim CG, et al. The association between Helicobacter pylori status and incidence of metachronous gastric cancer after endoscopic resection of early gastric cancer. Helicobacter. 2014 Jun;19(3):194–201.
Kato M, Nishida T, Yamamoto K, Hayashi S, Kitamura S, Yabuta T, et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group. Gut. 2013 Oct;62(10):1425–32.
Kato M, Asaka M, Ono S, Nakagawa M, Nakagawa S, Shimizu Y, et al. Eradication of Helicobacter pylori for primary gastric cancer and secondary gastric cancer after endoscopic mucosal resection. J Gastroenterol. 2007 Jan;42(S17 suppl 17):16–20.
Saka A, Yagi K, Nimura S. Endoscopic and histological features of gastric cancers after successful Helicobacter pylori eradication therapy. Gastric Cancer. 2016 Apr;19(2):524–30.
Mori G, Nakajima T, Asada K, Shimazu T, Yamamichi N, Maekita T, et al. Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan. Gastric Cancer. 2016 Jul;19(3):911–8.
Lian J, Chen S, Zhang Y, Qiu F. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc. 2012 Oct;76(4):763–70.
Ami R, Hatta W, Iijima K, Koike T, Ohkata H, Kondo Y, et al. Factors associated with metachronous gastric cancer development after endoscopic submucosal dissection for early gastric cancer. J Clin Gastroenterol. 2017 Jul;51(6):494–9.
Han SJ, Kim SG, Lim JH, Choi JM, Oh S, Park JY, et al. Long-term effects of Helicobacter pylori eradication on metachronous gastric cancer development. Gut Liver. 2018 Mar;12(2):133–41.
Nozaki K, Shimizu N, Ikehara Y, Inoue M, Tsukamoto T, Inada K, et al. Effect of early eradication on Helicobacter pylori-related gastric carcinogenesis in Mongolian gerbils. Cancer Sci. 2003 Mar;94(3):235–9.
You do not currently have access to this content.