To the Editor:
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. Consequently, they concluded that the "point of no return" may no longer be an issue.Recently, Kato et al
3
extended the follow-up period of a previous study and showed that H pylori eradication after ER of EGC had a preventive effect on the development of MGC in patients with mild to moderate atrophic gastritis, but this was not observed in severe atrophy.4
They compared patients with H pylori eradication within 1 year after ER to those without or with failed eradication. This finding can mean that atrophic severity can have interaction effects, a predictive factor of MGC, but not confounding factors as a prognostic value. Therefore, it is suggested that the "point of no return" may not be resolved in patients with severe gastric atrophy. A recent meta-analysis revealed that a preventive effect was more significant in patients with extended follow-up (≥5 years) (OR, 0.32; 95% CI, 0.24-0.43) than in those with short follow-up (<5 years) (OR, 0.55; 95% CI, 0.41-0.72).5
Therefore, we may need more additional observation times in patients with severe gastric atrophy to conclude whether the issue of the "point of no return" is resolved.Disclosure
All authors disclosed no financial relationships.
References
- 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.Gastrointest Endosc. 2020; 92: 613-622 e1
- Helicobacter pylori therapy for the prevention of metachronous gastric cancer.N Engl J Med. 2018; 378: 1085-1095
- 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
Kato M, Hayashi Y, Nishida T, et al. Helicobacter pylori eradication prevents secondary gastric cancer in patients with mild-to-moderate atrophic gastritis. J Gastroenterol Hepatol. Epub 2021 Jan 5.
- Effect of Helicobacter pylori eradication on the incidence of gastric cancer: a systematic review and meta-analysis.Gastric Cancer. 2019; 22: 435-445
Article info
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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 studyGastrointestinal EndoscopyVol. 92Issue 3
- ResponseGastrointestinal EndoscopyVol. 94Issue 1
- PreviewWe wish to thank Dr Nishida and his colleagues1 for their interest in our article.2 In the past, the benefit of Helicobacter pylori eradication was less evident if intestinal metaplasia occurred.3 This “point of no return” concept raised questions about the preventative effect of H pylori eradication therapy against metachronous gastric cancer in patients who underwent endoscopic resection for gastric cancer because they usually present with advanced precancerous lesions, including metaplasia, on histologic evaluation.
- Full-Text
- Preview
