Detection of Early Gastric Cancer after <b><i>Helicobacter pylori</i></b> Eradication

Abstract

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Based on evidence that &lt;i&gt;Helicobacter pylori&lt;/i&gt; eradication reduces the development of gastric cancer and other diseases such as peptic ulcer, eradication therapy has prevailed. However, gastric cancer can develop even after successful eradication. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; In this review article, we searched for studies that identified the characteristics of primary and metachronous gastric cancers after &lt;i&gt;H. pylori&lt;/i&gt; eradication, the risk factors for the development of these cancers after successful &lt;i&gt;H. pylori&lt;/i&gt; eradication, and whether image-enhanced endoscopy is useful for diagnosing gastric cancer after eradication. A gastritis-like appearance is seen as a characteristic endoscopic finding, which corresponds to an epithelium with low-grade atypia – also known as nonneoplastic epithelium – covering the surface of the cancerous glands. This finding may make endoscopic detection of early gastric cancer difficult after &lt;i&gt;H. pylori&lt;/i&gt; eradication. Similar risk factors, such as the male sex, endoscopic atrophy, histologic intestinal metaplasia, and late eradication, have been reported as predictors for the development of both primary and metachronous gastric cancers. Image-enhanced endoscopy, such as linked color imaging, may be useful for the detection and risk stratification of gastric cancer after eradication. &lt;b&gt;&lt;i&gt;Key Messages:&lt;/i&gt;&lt;/b&gt; Based on these findings, we believe that effective surveillance of high-risk patients leads to early detection of gastric cancer in the era of &lt;i&gt;H. pylori&lt;/i&gt; eradication.

Degree of Gastric Mucosal Atrophy Correlated Well with Gastric Cancer Occurrence in Patients with <i>Helicobacter pylori</i>-eradicated Status

“…However, successful eradication does not completely prevent gastric cancer occurrence, and the clarification of related risk factors in eradicated cases is clinically important for examiners using EGD. In previous investigations, several factors, such as an older age, smoking history, long-term usage of a PPI, and more severe GMA, have been demonstrated to be related to occurrence of gastric cancer (8)(9)(10). The results of the present study of H. pylori-eradicated patients who underwent EGD as part of an annual checkup showed that a smoking history and anti-secretory usage were not significant risk factors, whereas an older age at the time of H. pylori eradication and higher degree of GMA were demonstrated to be significant risk factors for gastric cancer occurrence.…”

“…The development of gastric cancer after successful eradication has been reported to be influenced by several factors, such as the age, time since eradication, smoking history, proton pump inhibitor (PPI) usage, and degree of gastric mucosal atrophy (GMA) (4)(5)(6)(8)(9)(10).…”

Global research trends of endoscope in early gastric cancer: A bibliometric and visualized analysis study over past 20 years

“…Shichijo et al. ( 51 ) showed that timely eradication of H. pylori also increased the risk of developing gastric cancer. Therefore, timely and effective detection and management of high-risk groups, as well as 2nd-look endoscopy, are necessary.…”

Gastric Cancer Screening in Japan: A Narrative Review

“…Moreover, recent development and widespread use of IEE and magnifying endoscopy have improved the endoscopic diagnosis of gastric cancer [ 23 ]. IEE is useful for diagnosing gastric cancer after eradication, which is usually difficult to detect [ 63 ]. In a recent study, we showed that photodynamic endoscopic diagnosis—based on the fluorescence of photosensitizers that accumulate in tumors—may be useful in the diagnosis of early gastric cancer regardless of the endoscopist’s experience and is useful for tumor detection; however, its usefulness has not been established because no prospective studies evaluating its usefulness have been performed [ 64 ].…”