Impact of the timing of Helicobacter pylori eradication on the risk of development of metachronous lesions after treatment of early gastric cancer: a population-based cohort study

      Background and Aims

      Helicobacter pylori eradication can reduce the risk of metachronous lesions after the treatment of early gastric cancer. We aimed to analyze the impact of the timing of H pylori eradication on metachronous recurrence.


      Data of patients who underwent endoscopic resection or partial gastrectomy for early stage gastric cancer and received H pylori eradication therapy were obtained from the Korean National Health Insurance Service database. Patients were classified into 3 groups according to the timing of the prescription for H pylori eradication: preresection; within 1 year postresection; and >1 year postresection.


      Among 19,767 patients, 7452 and 12,315 underwent endoscopic resection and surgery, respectively. The 5-year cumulative incidence of metachronous lesions after endoscopic resection was 14.0% in the preresection group, 12.3% in the within 1 year postresection group, and 16.9% in the >1 year postresection group. Surgery was performed in 1.2% of the preresection group, 1.3% of the within 1 year postresection group, and 2.9% of the >1 year postresection group. The within 1 year postresection group had a lower risk of development of metachronous lesions than the >1 year postresection group (hazard ratio [95% confidence interval]: after endoscopic resection, 0.79 [0.65–0.95]; after surgery, 0.39 [0.28–0.53]). The risk of development of metachronous lesions did not differ between the preresection and within 1 year postresection groups.


      Prescription of H pylori eradication therapy within 1 year after gastric cancer treatment reduces the risk of development of metachronous gastric neoplasms compared with a late prescription of eradication therapy in patients undergoing endoscopic resection and those undergoing surgery.


      BMI (body mass index), CI (confidence interval), EGC (early gastric cancer), HR (hazard ratio), ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), IQR (interquartile range), NHIS (National Health Insurance Service), RCT (randomized controlled trial)
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      Linked Article

      • Has the issue of the “point of no return” in gastric carcinogenesis already been resolved?
        Gastrointestinal EndoscopyVol. 94Issue 1
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          We have read the article focusing on the timing of Helicobacter pylori eradication on the risk of development of metachronous gastric cancer (MGC) after treatment of early gastric cancer (EGC) by Kim et al.1 The authors showed that the timing of H pylori eradication within 1 year after treatment was better to reduce the risk of development of MGC than the late timing based on a large-scale national insurance database. They described that this finding was supported by a randomized controlled study by Choi et al2 showing that H pylori eradication after endoscopic resection (ER) of EGC improved atrophy and intestinal metaplasia during the 3-year follow-up.
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