Background/Aims: Early-stage gastric cancer (EGC) is detected even after successful Helicobacter pylori eradication. This study is aimed at clarifying the clinicopathological characteristics of EGC detected after successful H. pylori eradication. Methods: This retrospective study analyzed 57 cases of EGC detected after successful H. pylori eradication and resected endoscopically at Kyoto Prefectural University of Medicine, between January 2009 and June 2014. Clinicopathological findings of 57 cases (H. pylori-eradicated group) were investigated, and compared with those in active H. pylori infection resected in the same period (H. pylori-positive group). Results: Most EGCs were detected in patients with severe atrophic mucosa, both in H. pylori-eradicated and H. pylori-positive groups, while the percentage of EGC detected in patients with mild atrophic mucosa gradually increased over time from successful eradication (H. pylori-positive: 7%, up to the fourth year since eradication: 11%, after the fifth year since eradication: 32%). The percentage of EGC detected in patients with mild atrophic mucosa after the fifth year since eradication was significantly higher than that in patients with active H. pylori infection (p = 0.004). Conclusion: After the fifth year following eradication, we should be alert to the incidence of EGC, irrespective of the severity of mucosal atrophic change.

Keywords:
Early-stage gastric cancer, Helicobacter pylori, Eradication, Detection, Mucosal atrophy
1.
Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, Taniyama K, Sasaki N, Schlemper RJ: Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001;345:784-789.
2.
Take S, Mizuno M, Ishiki K, Nagahara Y, Yoshida T, Yokota K, Oguma K, Okada H, Shiratori Y: The effect of eradicating helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease. Am J Gastroenterol 2005;100:1037-1042.
3.
Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, Terao S, Amagai K, Hayashi S, Asaka M: 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;372:392-397.
4.
Yanaoka K, Oka M, Ohata H, Yoshimura N, Deguchi H, Mukoubayashi C, Enomoto S, Inoue I, Iguchi M, Maekita T, Ueda K, Utsunomiya H, Tamai H, Fujishiro M, Iwane M, Takeshita T, Mohara O, Ichinose M: Eradication of Helicobacter pylori prevents cancer development in subjects with mild gastric atrophy identified by serum pepsinogen levels. Int J Cancer 2009;125:2697-2703.
5.
de Vries AC, Kuipers EJ, Rauws EA: Helicobacter pylori eradication and gastric cancer: when is the horse out of the barn? Am J Gastroenterol 2009;104:1342-1345.
6.
Takenaka R, Okada H, Kato J, Makidono C, Hori S, Kawahara Y, Miyoshi M, Yumoto E, Imagawa A, Toyokawa T, Sakaguchi K, Shiratori Y: Helicobacter pylori eradication reduced the incidence of gastric cancer, especially of the intestinal type. Aliment Pharmacol Ther 2007;25:805-812.
7.
Ogura K, Hirata Y, Yanai A, Shibata W, Ohmae T, Mitsuno Y, Maeda S, Watabe H, Yamaji Y, Okamoto M, Yoshida H, Kawabe T, Omata M: The effect of Helicobacter pylori eradication on reducing the incidence of gastric cancer. J Clin Gastroenterol 2008;42:279-283.
8.
Yamamoto K, Kato M, Takahashi M, Haneda M, Shinada K, Nishida U, Yoshida T, Sonoda N, Ono S, Nakagawa M, Mori Y, Nakagawa S, Mabe K, Shimizu Y, Moriya J, Kubota K, Matsuno Y, Shimoda T, Watanabe H, Asaka M: Clinicopathological analysis of early-stage gastric cancers detected after successful eradication of Helicobacter pylori. Helicobacter 2011;16:210-216.
9.
Kamada T, Hata J, Sugiu K, Kusunoki H, Ito M, Tanaka S, Inoue K, Kawamura Y, Chayama K, Haruma K: Clinical features of gastric cancer discovered after successful eradication of Helicobacter pylori: results from a 9-year prospective follow-up study in Japan. Aliment Pharmacol Ther 2005;21:1121-1126.
10.
Korenaga D, Watanabe A, Anai H, Maehara Y, Sugimachi K: Development of gastric cancer with special reference to growth and DNA content. Slow and rapid growing types. Eur J Surg Oncol 1993;19:463-467.
11.
Shimizu S, Tada M, Kawai K: Early gastric cancer: its surveillance and natural course. Endoscopy 1995;27:27-31.
12.
Haruma K, Suzuki T, Tsuda T, Yoshihara M, Sumii K, Kajiyama G: Evaluation of tumor growth rate in patients with early gastric carcinoma of the elevated type. Gastrointest Radiol 1991;16:289-292.
13.
Kato M, Nishida T, Yamamoto K, Hayashi S, Kitamura S, Yabuta T, Yoshio T, Nakamura T, Komori M, Kawai N, Nishihara A, Nakanishi F, Nakahara M, Ogiyama H, Kinoshita K, Yamada T, Iijima H, Tsujii M, Takehara T: 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;62:1425-1432.
14.
Lee HL, Eun CS, Lee OY, Han DS, Yoon BC, Choi HS, Hahm JS, Koh DH: When do we miss synchronous gastric neoplasms with endoscopy? Gastrointest Endosc 2010;71:1159-1165.
15.
Maehata Y, Nakamura S, Fujisawa K, Esaki M, Moriyama T, Asano K, Fuyuno Y, Yamaguchi K, Egashira I, Kim H, Kanda M, Hirahashi M, Matsumoto T: Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer. Gastrointest Endosc 2012;75:39-46.
16.
Take S, Mizuno M, Ishiki K, Yoshida T, Ohara N, Yokota K, Oguma K, Okada H, Yamamoto K: The long-term risk of gastric cancer after the successful eradication of Helicobacter pylori. J Gastroenterol 2011;46:318-324.
17.
Nakajima T, Oda I, Gotoda T, Hamanaka H, Eguchi T, Yokoi C, Saito D: Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance? Gastric Cancer 2006;9:93-98.
18.
Japanese Gastric Cancer Association: Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-123.
19.
Kimura K, Takemoto T: An endoscopic recognition of atrophic border and its significance in chronic gastritis. Endoscopy 1969;3:87-97.
20.
Kodama M, Murakami K, Okimoto T, Sato R, Uchida M, Abe T, Shiota S, Nakagawa Y, Mizukami K, Fujioka T: Ten-year prospective follow-up of histological changes at five points on the gastric mucosa as recommended by the updated Sydney system after Helicobacter pylori eradication. J Gastroenterol 2012;47:394-403.
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2017
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