Repeated Endoscopic Examination Six Months After H. Pylori Eradication Could Find Masked Gastric Cancer

Abstract

Background: Detecting early gastric cancer in H. pylori-infected stomach is not easy, when the background gastric mucosa shows severe inflammation with diffuse or patchy redness, edema, and thick mucous. In order to undertake less invasive therapies, such as endoscopic mucosal resection (EMR), it is important to find cancerous lesion(s) as small as possible. Since eradication of H. pylori is known to induce regression of inflamed gastric mucosa, repeated endoscopic examination after eradication could find previously masked cancerous lesion(s). Methods: Twenty-one cases (15 men: 51-88 years old, average 69.7 years of age) of early gastric cancer detected after H. pylori eradication were enrolled in this study. Eradication therapy was performed with LAC regimens (Lansoprazole 60 mg, Clarythromycin 800 mg, and Amoxycillin 1500 mg for 7 days) followed by 13 C-Urea Breath Test. Repeated endoscopic examination with high-resolution endoscopy (Olympus H260) was performed every 3 to 12 months' intervals after the eradication. Interval period detecting gastric cancer after the eradication and the size of lesion(s) were retrospectively analyzed. Results: Of twenty-one cases, 17 had previous EMR for early gastric cancer (13 cases) or gastric adenoma (4 cases). After H. pylori eradication, inflamed gastric mucosa regressed and thick mucous in the stomach decreased or disappeared in all cases. The mean interval period between detection of gastric cancer and eradication was 6.5 ± 0.9 months (range 2 to 12 months). The mean size of cancer was 8.5 ± 1.6 mm in diameter (range 3 to 18 mm). All cases were treated with EMR and only one case required additional operation due to deep invasion of gastric cancer. Conclusion: Eradication of H. pylori may make it easy to detect small early gastric cancer by regressing inflammation of gastric mucosa. It is highly recommended to perform repeated endoscopic examination at least first 6 months after eradication therapy in patients who had gastric cancer.