Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2020; 12(9): 276-284
Published online Sep 16, 2020. doi: 10.4253/wjge.v12.i9.276
Kyoto classification in patients who developed multiple gastric carcinomas after Helicobacter pylori eradication
Kosuke Sakitani, Toshihiro Nishizawa, Akira Toyoshima, Shuntaro Yoshida, Tatsuya Matsuno, Tomoharu Yamada, Masatoshi Irokawa, Yoshiyuki Takahashi, Yousuke Nakai, Osamu Toyoshima, Kazuhiko Koike
Kosuke Sakitani, Toshihiro Nishizawa, Shuntaro Yoshida, Tatsuya Matsuno, Tomoharu Yamada, Masatoshi Irokawa, Yoshiyuki Takahashi, Osamu Toyoshima, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Kosuke Sakitani, Department of Gastroenterology, Sakitani Endoscopy Clinic, Chiba 275-0026, Japan
Toshihiro Nishizawa, Department of Gastroenterology, International University of Health and Welfare, Narita Hospital, Chiba, 286-8520, Japan
Akira Toyoshima, Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
Tatsuya Matsuno, Tomoharu Yamada, Yousuke Nakai, Osamu Toyoshima, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Sakitani K wrote the manuscript; Sakitani K, Nishizawa T, Toyoshima A, Yoshida S, Matsuno T, Yamada T, Irokawa M, Takahashi Y, Toyoshima O collected and analyzed the data and revised the manuscript; Nakai Y, Koike K and Toyoshima O supervised the study; Toyoshima O conceived and designed the study.
Institutional review board statement: This retrospective study was approved by the Ethical Review Committee of Hattori Clinic on September 6, 2019 (approval no. S1909-U06).
Informed consent statement: Patients were not required to give informed consent the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Osamu Toyoshima, MD, Doctor, Department of Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan. t@ichou.com
Received: June 10, 2020
Peer-review started: June 10, 2020
First decision: July 21, 2020
Revised: July 29, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 16, 2020
Processing time: 91 Days and 23.7 Hours
ARTICLE HIGHLIGHTS
Research background

With the spread of eradication therapy for Helicobacter pylori (H. pylori), the number of patients with gastric cancer diagnosed for the first time after eradication therapy is on the rise; therefore, the analysis of these cases would become more important. Recently, Kyoto classification has been devised as a method for evaluation of endoscopic findings of the stomach, and its validity is being studied.

Research motivation

As far as we know, few data exist on the association between Kyoto classification and primary gastric cancer occurrence post H. pylori eradication therapy.

Research objectives

The purpose of this study was to develop Kyoto classification for differentiating between single and multiple gastric cancers in patients diagnosed with gastric cancer after H. pylori eradication.

Research methods

This retrospective study included 67 patients who were diagnosed with primary gastric cancer at least six months after the successful H. pylori eradication therapy between February 2010 to February 2019 in Toyoshima Endoscopy Clinic. We used data available from clinical charts and endoscopic database. We defined primary gastric cancer as pathologically diagnosed gastric cancer without past gastric neoplasm history. We divided these 67 gastric cancer patients into single gastric cancer patients and multiple gastric cancer patients. We defined multiple gastric cancer patients as those who had synchronous and/or metachronous gastric cancer. Patients without one or more follow-up endoscopy at our institution after primary gastric cancer diagnosis were excluded from the single gastric cancer patient group.

Research results

The Kyoto score at the time of diagnosis of 45 cases of gastric cancer after H. pylori eradication was 4.0 points in average. The score was 3.8 points in the single gastric cancer group, and 5.1 points in the multiple gastric cancers group. The multiple group had a significantly higher score than the single group (P = 0.016). In the multiple gastric cancers group, all the patients (7/7) had 5 or higher Kyoto score, while in single gastric cancer group, the proportion of patients with a score of 5 or higher was less than half, or 44.7% (17/38).

Research conclusions

Patients diagnosed with gastric cancer after H. pylori eradication tended to have advanced gastritis. In particular, in cases of multiple gastric cancers developed after H. pylori eradication, the endoscopic Kyoto classification score tended to be 5 or higher in patients with an open type atrophic gastritis and the intestinal metaplasia extended to the corpus.

Research perspectives

We believe that multiple gastric carcinomas could occur in the situation of so called “point of no return”, in which gastric carcinogenesis cascade had progressed to the advanced stage due to the H. pylori infection; therefore, even the eradication therapy could not repair the molecularly irreversible gastric mucosal changes.