Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?

Nakajima, Takeshi; Oda, Ichiro; Gotoda, Takuji; Hamanaka, Hisanao; Eguchi, Takako; Yokoi, Chizu; Saito, Daizo

doi:10.1007/s10120-006-0372-9

Cited by 193 publications

(219 citation statements)

References 27 publications

(27 reference statements)

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“…However, almost 20 % of the secondary lesions were also found more than 3 years after endoscopic resection, suggesting that long-term follow-up also cannot be ignored. In a previous study of metachronous gastric cancer after endoscopic resection, the overall incidence was reported to be 8.2 % during an average of 3.1 years of follow-up, and the cumulative 3-year incidence of metachronous gastric cancer was 5.9 % [19]. Another study reported that metachronous gastric cancers had an overall incidence of 14 % during a median of 57 months of follow-up [12], and yet another study showed the incidence of synchronous and metachronous multiple gastric cancers after endoscopic resection to be 14.5 and 8.5 %, respectively [15].…”

Section: Discussionmentioning

confidence: 95%

Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms

et al. 2014

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Background Despite many advantages, the development of synchronous or metachronous neoplasm is one of the main concerns with endoscopic resection. We aimed to clarify the independent risk factors for synchronous or metachronous gastric neoplasm. Methods We retrospectively reviewed the medical records of all patients who had undergone endoscopic resection for gastric high-grade dysplasia or early gastric cancer between April 2001 and February 2011. Results Among 971 subjects, 56 synchronous neoplasms and 42 metachronous neoplasms developed during 12-131 months of follow-up. In univariate analysis, age over 65 years, male gender, absence of Helicobacter pylori infection, lower third location, mucosal atrophy, and intestinal metaplasia were related to multiple gastric neoplasms. In multivariate analysis, absence of H. pylori infection [odds ratio (OR) 1.610, 95 % confidence interval (CI) 1.038-2.497)], lower third location (OR 1.704, 95 % CI 1.070-2.713), and intestinal metaplasia (OR 4.461, 95 % CI 1.382-14.401) were independent risk factors for multiple gastric neoplasms. For synchronous neoplasm, primary tumor size less than 1 cm was the only independent risk factor. For metachronous neoplasm, absence of H. pylori infection (OR 2.416, 95 % CI 1.214-4.810) was found to be the only independent risk factor. H. pylori eradication was found to be unrelated to the development of metachronous gastric neoplasms. Conclusions For tumors located in the antrum and accompanied by intestinal metaplasia, meticulous endoscopic evaluation with close follow-up after endoscopic resection is recommended.

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Section: Discussionmentioning

confidence: 95%

Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms

et al. 2014

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“…Since the proportion of patients with a different diagnosis in the response of matched pairs was 58 %, the sample size was set to 26 cancerous lesions. The frequency of synchronous or metachronous multiple gastric cancers in patients with previous gastric cancers was reported as 3-5 per 100 patient-years [18][19][20]. Moreover, it was reported that the frequency of synchronous or metachronous gastric cancers was 7.7 % in patients with esophageal cancer [21].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic ability of magnifying endoscopy with blue laser imaging for early gastric cancer: a prospective study

et al. 2016

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Background Blue laser imaging (BLI) is a new image-enhanced endoscopy technique that utilizes a laser light source developed for narrow-band light observation. The aim of this study was to evaluate the usefulness of BLI for the diagnosis of early gastric cancer. Methods This single center prospective study analyzed 530 patients. The patients were examined with both conventional endoscopy with white-light imaging (C-WLI) and magnifying endoscopy with BLI (M-BLI) at Kyoto Prefectural University of Medicine between November 2012 and March 2015. The diagnostic criteria for gastric cancer using M-BLI included an irregular microvascular pattern and/or irregular microsurface pattern, with a demarcation line according to the vessel plus surface classification system. Biopsies of the lesions were taken after C-WLI and M-BLI observation. The primary end point of this study was to compare the diagnostic performance between C-WLI and M-BLI. Results We analyzed 127 detected lesions (32 cancers and 95 non-cancers). The accuracy, sensitivity, and specificity of M-BLI diagnoses were 92.1, 93.8, and 91.6 %, respectively. On the other hand, the accuracy, sensitivity, and specificity of C-WLI diagnoses were 71.7, 46.9, and 80.0 %, respectively.Conclusions M-BLI had improved diagnostic performance for early gastric cancer compared with C-WLI. These results suggested that the diagnostic effectiveness of M-BLI is similar to that of magnifying endoscopy with narrow-band imaging (M-NBI).

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“…However, the development of metachronous gastric cancer (MGC), owing to the preservation of the entire stomach after endoscopic resection, remains a possibility [8][9][10]. A previous multicenter prospective randomized study performed in Japan showed that eradication of Helicobacter pylori reduced the incidence of MGC after endoscopic resection for early gastric cancer [11].…”

Section: Introductionmentioning

confidence: 99%

Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan

Mori

Nakajima

Asada³

et al. 2015

Gastric Cancer

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Background A previous multicenter prospective randomized study from Japan showed that Helicobacter pylori eradication reduced the development of metachronous gastric cancer (MGC) after endoscopic resection for early gastric cancer. MGC risk, however, is not eliminated; yet few studies have evaluated its long-term incidence and risk factors. In this study, we investigated the incidence of and risk factors for MGC in patients who underwent endoscopic resection for early gastric cancer with successful H. pylori eradication. Methods A total of 594 patients who underwent endoscopic resection for early gastric cancer and successful H. pylori eradication at three institutions (National Cancer Center Hospital, University of Tokyo Hospital, and Wakayama Medical University Hospital) were analyzed retrospectively. Annual endoscopic surveillance was performed after initial endoscopic resection. MGC was defined as a gastric cancer newly detected at least 1 year after successful H. pylori eradication. Results Ninety-four MGCs were detected in 79 patients during the 4.5-year median follow-up period. KaplanMeier analysis showed the cumulative incidence of MGC 5 years after successful H. pylori eradication was 15.0 %; the incidence of MGC calculated by use of the person-year method was 29.9 cases per 1000 person-years. Multivariate analysis using the Cox proportional hazards model revealed that male sex, severe gastric mucosal atrophy, and multiple gastric cancers before successful H. pylori eradication were independent risk factors for MGC. Eleven percent of MGCs (10 of 94) were detected more than 5 years after successful H. pylori eradication. Conclusion Surveillance endoscopy for MGC in patients who have undergone endoscopic resection for early gastric cancer should be performed even after successful H. pylori eradication.

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Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?

Abstract: In order to detect MGC at a stage early enough for a curative repeat ER, an annual endoscopic surveillance program is both practical and effective for post-ER patients.

Cited by 193 publications

References 27 publications

Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms

Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms

Diagnostic ability of magnifying endoscopy with blue laser imaging for early gastric cancer: a prospective study

Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan

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