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World J Gastroenterol. Mar 21, 2014; 20(11): 2760-2764
Published online Mar 21, 2014. doi: 10.3748/wjg.v20.i11.2760
Efficacy of Helicobacter pylori eradication for the prevention of metachronous gastric cancer after endoscopic resection for early gastric cancer
Jae Young Jang, Hoon Jai Chun
Jae Young Jang, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul 136-705, South Korea
Hoon Jai Chun, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea
Author contributions: Jang JY wrote the paper; Chun HJ designed and edited the paper.
Correspondence to: Hoon Jai Chun, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, South Korea. drchunhj@chol.com
Telephone: +82-2-9206555 Fax: +82-2-9531943
Received: August 16, 2013
Revised: November 9, 2013
Accepted: November 28, 2013
Published online: March 21, 2014
Abstract

Helicobacter pylori (H. pylori) plays an important role in gastric carcinogenesis, as the majority of gastric cancers develop from H. pylori-infected gastric mucosa. The rate of early gastric cancer diagnosis has increased in Japan and Korea, where H. pylori infection and gastric cancer are highly prevalent. Early intestinal-type gastric cancer without concomitant lymph node metastasis is usually treated by endoscopic resection. Secondary metachronous gastric cancers often develop because atrophic mucosa left untreated after endoscopic treatment confers a high risk of gastric cancer. The efficacy of H. pylori eradication for the prevention of metachronous gastric cancer remains controversial. However, in patients who undergo endoscopic resection of early gastric cancer, H. pylori eradication is recommended to suppress or delay metachronous gastric cancer. Careful and regularly scheduled endoscopy should be performed to detect minute metachronous gastric cancer after endoscopic resection.

Keywords: Helicobacter pylori, Gastric cancer, Endoscopic resection, Metachronous cancer

Core tip: In Japan and Korea, mucosal gastric cancer without concomitant lymph node metastasis is usually treated with endoscopic resection. However, gastric cancer recurrence following endoscopic resection is a significant problem. Secondary metachronous gastric cancers often develop due to atrophic mucosa left untreated after endoscopic treatment. Currently, all available evidence suggests that Helicobacter pylori (H. pylori) eradication represents a primary chemopreventive strategy. However, the efficacy of H. pylori eradication for the prevention of metachronous gastric cancer has been controversial. Therefore, endoscopists should inspect the entire stomach for minute or occult metachronous gastric cancer. In addition, regular surveillance endoscopy should be performed.