1. Effect of Helicobacter pylori Eradication on Metachronous Recurrence After Endoscopic Resection of Gastric Neoplasm Am J Gastroenterol 2014; 109:60–67 Suh Eun Bae, MD, Hwoon-Yong Jung, MD, PhD, AGAF, June Kang, MD, Young Soo Park, MD, PhD, Seunghee Baek, PhD, Ji-Hoon Jung, MD, Ji Young Choi, MD, Mi-Young Kim, MD, Ji Yong Ahn, MD, Kwi-Sook Choi, MD, Do Hoon Kim, MD, Jeong Hoon Lee, MD 1, Kee Don Choi, MD, PhD, Ho June Song, MD, PhD, Gin Hyug Lee, MD, PhD and Jin-Ho Kim, MD, PhD R4 윤 경 한 / Prof. 장 재 영

2. BACKGROUND

3. Backgrounds Risk factor for gastric adenocarcinoma Group 1 carcinogen for gastric cancer (IARC) H. pylori eradication - prophylactic effects on gastric cancer After endoscopic resection(ER) for gastric cancer, H. pylori eradication → Gastric cancer occurrence?? Helicobacter pylori (H. pylori) Peptic ulcer disease Gastric MALToma Early gastric cancer Chronic atrophic gastritis - 한국인 헬리코박터 파일로리 감염의 진단과 치료 임상 진료지침 개정안 2013

4. METHODS

5. Figure 1. Patient flow diagram. EGC, early gastric cancer; ER, endoscopic resection; Hp, Helicobacter pylori. Methods -patients * Triple therapy - PPI ( lansoprazole 30mg or pantoprazole 40mg or omeprazole 30mg bid ) - Amoxicillin 750 mg bid - Clarithromycin 200mg bid

6. Methods Follow-up schedule  Margin (lateral and vertical) and lymphovascular invasion check  Submucosal invasion of more than 500 μm or positive lymphovascular invasion → Operation & not enrolled  After endoscopic resection surveillance  Endoscopy by forceps biopsy and/or computed tomography scan  Post-ER 3, 6, 12, 18, and 24 months, and a 1-year interval thereafter

7. Methods Histopathologic examinations  Accurately diagnosed with early gastric cancer ?  At least 1 cm distal to the tumor margin Outcome measures  Primary outcome measure - Rate of metachronous recurrence of gastric cancer at follow-up in 1,007 patients  Secondary outcome measure - Rate of metachronous recurrence of gastric neoplasm at follow- up in 1,487 patients with gastric low grade neoplasia and early gastric cancer  Metachronous recurrence occurring within 6 months was excluded

8. RESULTS

9. Table 1. Baseline characteristics of the enrolled patients

10. RESULTS Table 2. Metachronous recurrence rate and duration of follow-up in the three groups

11. Figure 2. Kaplan – Meier analysis of recurrence-free survival. Follow-up after endoscopic resection. Noneradicated Hp negative Eradicated

12. Figure 2. Kaplan – Meier analysis of recurrence-free survival. follow-up after determination of H. pylori status after eradication.

13. RESULTS Table 3. Univariate and multivariate Cox proportional hazards model for recurrence-free survival

14. RESULTS Table 4. Univariate and multivariate Cox proportional hazards model for recurrence-free survival in patients with gastric low-grade neoplasia and early gastric cancer

15. CONCLUSIONS

16. Conclusions  Successful H. pylori eradication may reduce the occurrence of metachronous gastric cancer after endoscopic resection in patients with early gastric cancer.. ERADICATION Metachronous gastric cancer