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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2015; 21(37): 10553-10562
Published online Oct 7, 2015. doi: 10.3748/wjg.v21.i37.10553
Endoscopic surveillance of gastric cancers after Helicobacter pylori eradication
Masaaki Kobayashi, Yuichi Sato, Shuji Terai
Masaaki Kobayashi, Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata 949-7302, Japan
Yuichi Sato, Shuji Terai, Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
Author contributions: Kobayashi M, Sato Y and Terai S contributed to this paper.
Conflict-of-interest statement: The authors declare that they do not have a current financial arrangement or affiliation with any organization that may have a direct interest in their work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaaki Kobayashi, MD, PhD, Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4123 Urasa, Minami-Uonuma, Niigata 949-7302, Japan. masakoba@med.niigata-u.ac.jp
Telephone: +81-25-7773200 Fax: +81-25-7772811
Received: April 28, 2015
Peer-review started: May 7, 2015
First decision: June 23, 2015
Revised: July 5, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: October 7, 2015
Abstract

The incidence and mortality of gastric cancer remains high in East Asian countries. Current data suggest that Helicobacter pylori (H. pylori) eradication might be more effective for preventing gastric cancer in young people before they develop atrophic gastritis and intestinal metaplasia. However, the long-term effect of H. pylori eradication on metachronous cancer prevention after endoscopic resection (ER) of early gastric cancer remains controversial, with some discordance between results published for Japanese and Korean studies. The detection ability of synchronous lesions before ER and eradication of H. pylori directly influences these results. After eradication, some gastric cancers are more difficult to diagnose by endoscopy because of morphologic changes that lead to a flat or depressed appearance. Narrow-band imaging with magnifying endoscopy (NBI-ME) is expected to be useful for identifying metachronous cancers. However, some gastric cancers after eradication show a “gastritis-like” appearance under NBI-ME. The gastritis-like appearance correlates with the histological surface differentiation of the cancer tubules and superficial non-neoplastic epithelium atop or interspersed with the cancer. Till date, it remains unclear whether H. pylori eradication could prevent progression of gastric cancer. Until we can establish more useful endoscopic examination methodologies, regular endoscopic surveillance of high-risk groups is expected to be the most beneficial approach for detection.

Keywords: Gastric cancer, Helicobacter pylori, Atrophic gastritis, Narrow-band imaging, Magnifying endoscopy, Endoscopic resection

Core tip: Although Helicobacter pylori (H. pylori) eradication may prevent the development of gastric cancer, tumors can occur despite successful eradication. The characteristics and management of these cancers have therefore become major clinical issues. Because of indistinct borderline or surface structure, it is often difficult to diagnose gastric cancer using narrow-band imaging with magnifying endoscopy after eradication. We review the effect of H. pylori eradication on metachronous cancer prevention, endoscopic and histopathological findings of gastric cancers discovered after eradication, and discuss effective management strategies for early gastric cancer.