Choi, Ji Min; Kim, Sang Gyun; Choi, Jeongmin; Park, Jae Yong; Oh, Sooyeon; Yang, Hyo-Joon; Lim, Joo Hyun; Im, Jong Pil; Kim, Joo Sung; Jung, Hyun Chae
Gastrointestinal endoscopy
2018May ; 74 ( 6 ) :.
PMID : 29800546
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Choi, Ji Min - Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
Kim, Sang Gyun - Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Choi, Jeongmin - Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Park, Jae Yong - Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Oh, Sooyeon - Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Yang, Hyo-Joon - Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Lim, Joo Hyun - Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
Im, Jong Pil - Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Kim, Joo Sung - Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Jung, Hyun Chae - Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
ABSTRACT
BACKGROUND AND AIMS: Whether eradication of Helicobacter pylori reduces the incidence of metachronous gastric cancer (MGC) is still debatable. We aimed to evaluate the long-term effect of H pylori eradication on the development of MGC after endoscopic gastric tumor resection.
METHODS: We undertook an open-label, prospective, randomized controlled trial at a tertiary hospital in Seoul, Korea. Participants were recruited during April 2005 to February 2011 and followed until December 2016. We assigned 898 patients with H pylori infection treated with endoscopic resection (ER) for gastric dysplasia or early gastric cancer to receive (n?=442) or not receive (n?=456) eradication therapy using a random-number chart. Eradication group patients received oral omeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg twice daily for a week, whereas control group patients received no H pylori treatment. The primary outcome was the incidence of MGC (intention-to-treat analysis).
RESULTS: The 877 patients who attended??? follow-up examination (eradication group, 437; control group, 440) were analyzed. Median follow-up was 71.6 months (interquartile range, 42.1-90.0). MGC developed in 18 (4.1%) eradication and 36 (8.2%) control group patients (log-rank test, P?= .01). In our yearly analysis, the effect of eradication showed a significant difference in 5 years after allocation (log-rank test, P?= .02). The adjusted hazard ratio for the control group was 2.02 (95% CI, 1.14-3.56; P?= .02), compared with the eradication group.
CONCLUSIONS: H pylori eradication significantly reduces the incidence of MGC after ER of gastric tumors and should be considered for H pylori-positive gastric tumor patients treated with ER. (Clinical trial registration number: NCT01510730.). CI - Copyright ??2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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