Preventing metachronous gastric lesions after endoscopic submucosal dissection through Helicobacter pylori eradication
Preventing metachronous gastric lesions after endoscopic submucosal dissection through Helicobacter pylori eradication
复制标题
DOI：
10.1111/jgh.12687
复制
发表时间：
2015-01-01
影响因子：
4.1
通讯作者：
Lee, Sang Kil
中科院分区：
文献类型：
--
作者：
Jung, Sungmo;Park, Chan Hyuk;Lee, Sang Kil
背景和目的早期胃癌内镜粘膜下剥离术后经常发生异时复发，且预防复发的方法尚不清楚。我们的目的是确定异时性病变的危险因素，以及使用阿司匹林和根除幽门螺杆菌对预防复发的影响。方法对2007年1月至2011年12月期间连续1041例因早期胃癌接受内镜粘膜下剥离术的患者进行回顾性分析。每名患者在内镜粘膜下剥离术后 2、6 和 12 个月进行内镜检查，然后每年进行一次内镜检查。根据是否存在异时性病变将患者分为异时性组和非异时性组，并根据幽门螺杆菌状态细分为未感染、感染后根除和未根除三组。结果中位随访39个月时，35例患者（3.4%）出现异时性胃病变，其中异型增生16例，癌症19例。异时组年龄显着高于非异时组（P=0.02）。尽管非异时组服用阿司匹林的频率高于异时组（15.5% vs 5.7%），但差异无统计学意义（P=0.11）。在未根除组中，与未感染组相比，异时病变的优势比为7.762（95%置信区间，1.483-60.854；P=0.02）。根除组与未感染组相比，异时性病变的奇数比为8.120（95%置信区间，1.950~58.985；P=0.01）。结论幽门螺杆菌感染是胃异时性病变的独立危险因素。然而，仅根除幽门螺杆菌并不能预防发炎胃中的所有异时病变。
Background and AimMetachronous recurrence often occurs after endoscopic submucosal dissection for early gastric cancer, and a method for preventing recurrence is unknown. We aimed to identify risk factors for metachronous lesions, and the effects of aspirin use and Helicobacter pylori eradication on preventing recurrence.MethodsA total of 1041 consecutive patients who underwent endoscopic submucosal dissection for early gastric cancer between January 2007 and December 2011 were retrospectively analyzed. Every patient was examined endoscopically at 2, 6, and 12 months after endoscopic submucosal dissection, and then annually. Patients were classified into the metachronous group or non-metachronous group according to the existence of metachronous lesions and subdivided by Helicobacter pylori status into three groups: not infected, eradicated after infection, and not eradicated.ResultsAt 39 months' median follow-up, metachronous gastric lesions had developed in 35 patients (3.4%), including 16 with dysplasia and 19 cancers. Metachronous group were significantly older than non-metachronous group (P=0.02). Although non-metachronous group took aspirin more frequently than metachronous group (15.5% vs 5.7%), the difference was statistically insignificant (P=0.11). In the not eradicated group, the odds ratio of metachronous lesion was 7.762 compared with the not infected group (95% confidence interval, 1.483-60.854; P=0.02). In the eradicated group, the odd ratio of metachronous lesion was 8.120 compared with not infected group (95% confidence interval, 1.950-58.985; P=0.01).ConclusionHelicobacter pylori infection was an independent risk factor for metachronous gastric lesions. However, eradication of Helicobacter pylori alone does not prevent all metachronous lesions in an inflamed stomach.