IMPORTANCE OF ENDOSCOPIC SURVEILLANCE AFTER HELICOBACTER PYLORI ERADICATION

Abstract

Helicobacter pylori (H. pylori) infection is a major pathogen of gastric cancer, and many cohort studies, randomized controlled trials, and meta-analyses have shown that eradication therapy suppresses gastric cancer development. However, gastric cancer is not completely suppressed even after eradication, and post-eradication gastric cancer remains a problem. The risk factors for post-eradication gastric cancer include male sex, advanced age, high degree of atrophy and intestinal metaplasia, and the appearance of map-like erythema, which is difficult to identify due to the epithelium with low grade atypia and endoscopic gastritis-like findings on the surface. Most post-eradication gastric cancers are of the differentiated type, but undifferentiated gastric cancers are often advanced; thus, careful endoscopic surveillance is required. Ten years after eradication, the incidence of undifferentiated gastric cancer increases in patients with mild to moderate atrophy, and lack of follow-up after eradication is a risk factor of undifferentiated gastric cancer. Recent studies have shown that careful endoscopic follow-up with specific and magnifying endoscopy more than 10 years after eradication, the degree of abnormal gastric mucosal DNA methylation, the Kyoto Classification of Gastritis, and the other indicators may be useful for the early detection and treatment of gastric cancer after H. pylori eradication.