To the Editor:We have read the article focusing on the timing of Helicobacter pylori eradication on the risk of development of metachronous gastric cancer (MGC) after treatment of early gastric cancer (EGC) by Kim et al.1Kim H.J. Kim Y.J. Seo S.I. et al.Impact of the timing of Helicobacter pylori eradication on the risk of development of metachronous lesions after treatment of early gastric cancer: a population-based cohort study. The authors showed that the timing of H pylori eradication within 1 year after treatment was better to reduce the risk of development of MGC than the late timing based on a large-scale national insurance database. They described that this finding was supported by a randomized controlled study by Choi et al2Choi I.J. Kook M.C. Kim Y.I. et al.Helicobacter pylori therapy for the prevention of metachronous gastric cancer. showing that H pylori eradication after endoscopic resection (ER) of EGC improved atrophy and intestinal metaplasia during the 3-year follow-up. Consequently, they concluded that the "point of no return" may no longer be an issue.Recently, Kato et al3Kato M. Nishida T. Yamamoto K. et al.Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group. extended the follow-up period of a previous study and showed that H pylori eradication after ER of EGC had a preventive effect on the development of MGC in patients with mild to moderate atrophic gastritis, but this was not observed in severe atrophy.4

Kato M, Hayashi Y, Nishida T, et al. Helicobacter pylori eradication prevents secondary gastric cancer in patients with mild-to-moderate atrophic gastritis. J Gastroenterol Hepatol. Epub 2021 Jan 5.

They compared patients with H pylori eradication within 1 year after ER to those without or with failed eradication. This finding can mean that atrophic severity can have interaction effects, a predictive factor of MGC, but not confounding factors as a prognostic value. Therefore, it is suggested that the "point of no return" may not be resolved in patients with severe gastric atrophy. A recent meta-analysis revealed that a preventive effect was more significant in patients with extended follow-up (≥5 years) (OR, 0.32; 95% CI, 0.24-0.43) than in those with short follow-up (5Effect of Helicobacter pylori eradication on the incidence of gastric cancer: a systematic review and meta-analysis. Therefore, we may need more additional observation times in patients with severe gastric atrophy to conclude whether the issue of the "point of no return" is resolved.Disclosure

All authors disclosed no financial relationships.

ReferencesKim H.J. Kim Y.J. Seo S.I. et al.

Impact of the timing of Helicobacter pylori eradication on the risk of development of metachronous lesions after treatment of early gastric cancer: a population-based cohort study.

Gastrointest Endosc. 92: 613-622 e1Choi I.J. Kook M.C. Kim Y.I. et al.

Helicobacter pylori therapy for the prevention of metachronous gastric cancer.

N Engl J Med. 378: 1085-1095Kato M. Nishida T. Yamamoto K. et al.

Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group.

Gut. 62: 1425-1432

Kato M, Hayashi Y, Nishida T, et al. Helicobacter pylori eradication prevents secondary gastric cancer in patients with mild-to-moderate atrophic gastritis. J Gastroenterol Hepatol. Epub 2021 Jan 5.

Effect of Helicobacter pylori eradication on the incidence of gastric cancer: a systematic review and meta-analysis.

Gastric Cancer. 22: 435-445Article InfoIdentification

DOI: https://doi.org/10.1016/j.gie.2021.02.006

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© 2021 by the American Society for Gastrointestinal Endoscopy

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