Kwon Y, et al. – Objectives of this retrospective analysis were to determine whether serum level of pepsinogen (PG), a marker of gastric atrophy, could determine which patients who had undergone endoscopic submucosal dissection for early gastric cancer (EGC) were at risk for metachronous gastric neoplasm and to examine the impacts of Helicobacter pylori eradication on metachronous gastric neoplasm incidence. The researchers concluded that eradication of H. pylori infection reduced the risk of metachronous gastric neoplasm. After endoscopic submucosal dissection, serum ratio of PGI:PGII of 3 or less also increased the risk of metachronous gastric neoplasm.

Methods

• From January 2008 to May 2013, the researchers conducted a retrospective study of 590 consecutive patients who underwent endoscopic submucosal dissection for EGC, at a tertiary centre in South Korea.
• For this study, serum levels of PG were measured at the time of endoscopic submucosal dissection and H. pylori infection status were recorded.
• Eradication treatment was provided in case of proven presence of current H. pylori infection.
• Patients underwent follow-up endoscopies at 3 months, 9 months, and each year after the procedure to detect neoplasms and were tested for H. pylori infection.
• They measured serum levels of PG at these time points from 442 of the patients.
• They evaluated the main and sub-cohorts for baseline characteristics, H. pylori infection, serum level of PG, and metachronous gastric neoplasm lesions.

Results

• 64 patients developed metachronous gastric neoplasms during a median follow-up period of 47.7 months.
• Risk factors for metachronous gastric neoplasm included persistent H. pylori infection (hazard ratio [HR], 2.532; P = .022) and serum ratio of PGI:PGII of three or less at the time of endoscopic submucosal dissection (HR, 1.881; P = .018) in multivariate analysis of the main cohort (n = 590).
• Persistent H. pylori infection (odds ratio [OR], 4.404; P = .009) and persistent decrease in mean serum ratio of PGI:PGII to 3 or less were associated with increased risk of metachronous gastric neoplasm (OR, 2.141; P = .039) among patients with serum PG measurements.