Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2020; 12(9): 276-284
Published online Sep 16, 2020. doi: 10.4253/wjge.v12.i9.276
Kyoto classification in patients who developed multiple gastric carcinomas after Helicobacter pylori eradication
Kosuke Sakitani, Toshihiro Nishizawa, Akira Toyoshima, Shuntaro Yoshida, Tatsuya Matsuno, Tomoharu Yamada, Masatoshi Irokawa, Yoshiyuki Takahashi, Yousuke Nakai, Osamu Toyoshima, Kazuhiko Koike
Kosuke Sakitani, Toshihiro Nishizawa, Shuntaro Yoshida, Tatsuya Matsuno, Tomoharu Yamada, Masatoshi Irokawa, Yoshiyuki Takahashi, Osamu Toyoshima, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Kosuke Sakitani, Department of Gastroenterology, Sakitani Endoscopy Clinic, Chiba 275-0026, Japan
Toshihiro Nishizawa, Department of Gastroenterology, International University of Health and Welfare, Narita Hospital, Chiba, 286-8520, Japan
Akira Toyoshima, Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
Tatsuya Matsuno, Tomoharu Yamada, Yousuke Nakai, Osamu Toyoshima, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Sakitani K wrote the manuscript; Sakitani K, Nishizawa T, Toyoshima A, Yoshida S, Matsuno T, Yamada T, Irokawa M, Takahashi Y, Toyoshima O collected and analyzed the data and revised the manuscript; Nakai Y, Koike K and Toyoshima O supervised the study; Toyoshima O conceived and designed the study.
Institutional review board statement: This retrospective study was approved by the Ethical Review Committee of Hattori Clinic on September 6, 2019 (approval no. S1909-U06).
Informed consent statement: Patients were not required to give informed consent the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Osamu Toyoshima, MD, Doctor, Department of Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan. t@ichou.com
Received: June 10, 2020
Peer-review started: June 10, 2020
First decision: July 21, 2020
Revised: July 29, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 16, 2020
Abstract
BACKGROUND

Endoscopic Kyoto classification predicts gastric cancer risk; however, the score in the patients with primary gastric cancer after Helicobacter pylori (H. pylori) eradication therapy is unknown.

AIM

To elucidate the Kyoto classification score in patients with both single gastric cancer and multiple gastric cancers developed after H. pylori eradication.

METHODS

The endoscopist recorded the Kyoto classification at the endoscope and the Kyoto classification score at the time of the first diagnosis of gastric cancer after H. pylori eradication. The score was compared between single gastric cancer group and multiple gastric cancers group.

RESULTS

The Kyoto score at the time of diagnosis of 45 cases of gastric cancer after H. pylori eradication was 4.0 points in average. The score was 3.8 points in the single gastric cancer group, and 5.1 points in the multiple gastric cancers group. The multiple group had a significantly higher score than the single group (P = 0.016). In the multiple gastric cancers group, all the patients (7/7) had 5 or higher Kyoto score, while in single gastric cancer group, the proportion of patients with a score of 5 or higher was less than half, or 44.7% (17/38).

CONCLUSION

Patients diagnosed with gastric cancer after H. pylori eradication tended to have advanced gastritis. In particular, in cases of multiple gastric cancers developed after H. pylori eradication, the endoscopic Kyoto classification score tended to be 5 or higher in patients with an open type atrophic gastritis and the intestinal metaplasia extended to the corpus.

Keywords: Kyoto classification, Gastric cancer, Helicobacter pylori, Eradication therapy, Metachronous, Intestinal metaplasia

Core Tip: This is a retrospective study to elucidate the endoscopic Kyoto classification score in patients with both single gastric cancer and multiple gastric cancers developed after Helicobacter pylori (H. pylori) eradication. The Kyoto score of 45 cases of gastric cancer after H. pylori eradication was 4.0 points in average. The score was 3.8 points in the single gastric cancer group, and 5.1 points in the multiple gastric cancers group. In cases of multiple gastric cancers, the Kyoto classification score tended to be 5 or higher with an open type atrophic gastritis and the intestinal metaplasia extended to the corpus.