Otsuka T, Sugimoto M, Ban H, Nakata T, Murata M, Nishida A, Inatomi O, Bamba S, Andoh A. Severity of gastric mucosal atrophy affects the healing speed of post-endoscopic submucosal dissection ulcers. World J Gastrointest Endosc 2018; 10(5): 83-92 [PMID: 29774087 DOI: 10.4253/wjge.v10.i5.83]
Corresponding Author of This Article
Mitsushige Sugimoto, MD, PhD, Associate Professor, Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu 520-2192, Japan. sugimo@belle.shiga-med.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Taketo Otsuka, Mitsushige Sugimoto, Hiromitsu Ban, Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan
Toshiro Nakata, Masaki Murata, Atsushi Nishida, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan
Author contributions: Otsuka T, Sugimoto M, Ban H, Nakata T, Murata M, Nishida A, Inatomi O, Bamba S and Andoh A contributed to study conception and design; Otsuka T, Sugimoto M, Ban H, Nakata T and Murata M contributed to data acquisition; Otsuka T and Sugimoto M contributed to data analysis and interpretation; Otsuka T and Sugimoto M wrote the paper; Otsuka T and Sugimoto M contributed to editing.
Institutional review board statement: Approval for the study protocol was given in advance by the Institutional Review Board of the Shiga University of Medicine Science (Number 27-36).
Conflict-of-interest statement: None of the authors have any conflicts of interest related to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mitsushige Sugimoto, MD, PhD, Associate Professor, Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu 520-2192, Japan. sugimo@belle.shiga-med.ac.jp
Telephone: +81-77-5482618 Fax: +81-77-5482618
Received: January 30, 2018 Peer-review started: January 31, 2018 First decision: February 27, 2018 Revised: March 4, 2018 Accepted: March 20, 2018 Article in press: March 20, 2018 Published online: May 16, 2018 Processing time: 106 Days and 6.4 Hours
Abstract
AIM
To investigate factors associated with the healing of endoscopic submucosal dissection (ESD)-induced ulcers.
METHODS
We enrolled 132 patients with gastric tumors scheduled for ESD. Following ESD, patients were treated with daily lansoprazole 30 mg or vonoprazan 20 mg. Ulcer size was endoscopically measured on the day after ESD and at 4 and 8 wk. The gastric mucosa was endoscopically graded according to the Kyoto gastritis scoring system. We assessed the number of patients with and without a 90% reduction in ulcer area at 4 wk post-ESD and scar formation at 8 wk, and looked for risk factors for slower healing.
RESULTS
The mean size of gastric tumors and post-ESD ulcers was 17.4 ± 12.1 mm and 32.9 ± 13.0 mm. The mean reduction rates in ulcer area were 90.4% ± 0.8% at 4 wk and 99.8% ± 0.1% at 8 wk. The reduction rate was associated with the Kyoto grade of gastric atrophy at 4 wk (A0: 97.9% ± 0.6%, A1: 93.4% ± 4.1%, and A2: 89.7% ± 1.0%, respectively). In multivariate analysis, the factor predicting 90% reduction at 4 wk was gastric atrophy (Odds ratio: 5.678, 95%CI: 1.190-27.085, P = 0.029).
CONCLUSION
The healing speed of post-ESD ulcers was associated with the degree of gastric mucosal atrophy, and Helicobacter pylori eradication therapy is required to perform at younger age.
Core tip: It is important to investigate factors influencing the healing speed of endoscopic submucosal dissection (ESD)-induced ulcers to prevent gastrointestinal bleeding. Although previous studies have looked at many factors related to ESD-induced ulcer healing, such as location of the tumor, submucosal fibrosis, initial ulcer size, diabetes, and method of gastric acid suppression, this report showed that the severity of gastric atrophy is possible factor to affect speed of ESD-induced ulcer healing. Therefore, Helicobacter pylori (H. pylori) eradication therapy is required to perform at younger age before progression of gastric mucosal atrophy to prevent development of H. pylori-related diseases and bleeding from ESD-induced ulcer.
