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Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
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Kichul Yoon1,2, Nayoung Kim1,3, Jaeyeon Kim3, Jung Won Lee3, Hye Seung Lee4, Jong-Chan Lee1, Hyuk Yoon1, Cheol Min Shin1, Young Soo Park1, Sang-Hoon Ahn5, Do Joong Park5, Hyung Ho Kim5, Yoon Jin Lee6, Kyoung-Ho Lee6, Young-Hoon Kim6, Dong Ho Lee1,3
Correspondence to: Nayoung Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173beon-gil, Bundang-gu, Seongnam 13620, Korea, Tel: +82-31-787-7008, Fax: +82-31-787-4051, E-mail: nayoungkim49@empas.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver 2017;11(2):209-215. https://doi.org/10.5009/gnl16224
Published online November 14, 2016, Published date March 15, 2017
Copyright © Gut and Liver.
Patients who underwent curative gastrectomy at Seoul National University Bundang Hospital and had a positive One hundred forty patients (mean age, 59.0 years; 60.7% male) underwent subtotal gastrectomy with B-I (65.0%), B-II (27.1%), Roux-en-Y (4.3%), jejunal interposition (0.7%), or proximal gastrectomy (4.3%). Preoperative presence of AG (62.9%) and IM (72.9%) was confirmed. The mean period between surgery and the last endoscopic follow-up was 38.0±25.6 months. Of the 140 patients, 80 (57.1%) were found to be persistently positive for A high percentage of spontaneous regression and complex dynamic changes in Background/Aims
Methods
Results
Conclusions
Keywords:
Gastric cancer had been the most common cause of cancer deaths worldwide until the 1990s.1 Although decreasing trends in incidence and mortality rates have been observed, stomach cancer is still the second leading cause of cancer death worldwide.2,3 Chronic infection with
Asia-Pacific consensus guideline suggested that
From this background, the aim of the present study was to evaluate the postoperative changes of
Patients who underwent gastric cancer surgery at Seoul National University Bundang Hospital with positive
This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital and written informed consent was obtained from all participants (IRB number: B-1510/320-116).
Preoperatively, four biopsy specimens were obtained from the antrum and the mid body of the stomach, respectively. After surgery, three tissue samples from lesser curvature and greater curvature of remained body were biopsied. Both Campylobacter like organism (CLO) test and Giemsa stain were done on every patient pre- and postoperatively.
Tissue sections were stained with modified Giemsa to prove the presence of
The patients with persistent
All statistical analyses were performed using the SPSS software version 18.0 (SPSS Inc., Chicago, IL, USA). Student t-test and chi-square test were used to compare the baseline characteristics between persistently positive- and spontaneous negative conversion group. To assess the factors related with postoperative
A total of 140 biopsy proven stomach cancer patients (mean age, 59.0 years; 85 male [60.7%]) with known
All patients had undergone gastrectomy (subtotal gastrectomy with B-I, 91 [65.0%]; B-II, 38 [27.1%]; Roux-en-Y, 4 [4.3%]; jejunal interposition, 1 [0.7%]; proximal gastrectomy, 6 [4.3%]). There were 69 (49.3%) of intestinal and 69 (49.3%) of diffuse type cancers according to Lauren classification. Mean size of cancer lesion was 3.79±2.3 cm. Histologic AG and IM were confirmed to be present (AG, 88 [62.9%]; IM, 102 [72.9%]) before surgery.
After surgery, annual follow-up was planned, and all 140 patients underwent endoscopy at least once (up to seven times). Forty-four patients (31.5%) were followed up more than twice. The mean interval between surgery and the first follow-up was 25.3±19.8 months. Mean follow-up period between surgery and the last endoscopic follow up was 38.0±25.6 months (Table 2).
All patients had their
After surgery, 60 patients (42.9%) showed spontaneous
We compared variables between the patients who had persistent
The distribution for the presence of AG and IM was not different between two groups at the baseline biopsy. However, there were significant changes based on the first postoperative biopsy results (Table 3). Spontaneous negative conversion group showed trend of having more IM compared to the
It is controversial whether
In the present study, spontaneous negative conversion of
In our study, there was no significant difference between spontaneous conversion and persistently positive groups according to surgery type, which could affect the bile reflux. It could suggest that IM could be a more important factor for the survival of
As remnant stomach has different anatomic and biological environment, there have been several studies to investigate the efficacy of postoperative eradication therapy.11,24–27 However, the number of subjects in those studies was relatively small, and the time from the operation to the eradication therapy was too long. Moreover, eradication regimen in some studies is not applicable nowadays because PPI based dual therapy was used instead of PPI-based triple therapy in the earlier studies.24,25 In addition, it is sometimes difficult to interpret the eradication in the gastric remnant as dynamic changes frequently occur. Therefore, careful serial follow-up is necessary to define “true spontaneous regression.”
The present study is a comprehensive study with relatively long duration of follow-up around 3 years. It also confirmed
In conclusion, we observed that there was relatively high percentage of spontaneous regression and dynamic changes in status of
This work was supported by the Global Core Research Center (GCRC) grant (2011-0030001) from the National Research Foundation (NRF), Ministry of Education, Science and Technology (MEST), Republic of Korea.
Baseline Characteristics of 140 Patients with Biopsy-Confirmed Stomach Cancer
Variable | Value |
---|---|
Age, yr | 59.0±11.54 |
Sex | |
Male | 85 (60.7) |
Female | 55 (39.3) |
Lauren classification | |
Intestinal | 69 (49.3) |
Diffuse | 69 (49.3) |
Mixed | 2 (1.4) |
EGC or AGC | |
EGC | 91 (65.0) |
AGC | 49 (35.0) |
Cancer location | |
Antrum | 63 (45.0) |
Body | 65 (46.4) |
Antrum and body | 7 (5.0) |
Cardia | 5 (3.6) |
Surgery type | |
Subtotal gastrectomy | |
Billroth I | 91 (65.0) |
Billroth II | 38 (27.1) |
Roux-en-Y | 4 (4.3) |
With jejunal interposition | 1 (0.7) |
Proximal gastrectomy | 6 (4.3) |
Smoking | |
Never | 57 (40.7) |
Current | 29 (20.7) |
Ex-smoker | 54 (38.6) |
Alcohol | |
None | 69 (49.3) |
Social | 53 (37.9) |
Heavy* | 18 (12.9) |
Atrophic gastritis | |
Negative | 34 (24.3) |
Positive | 88 (62.9) |
Not applicable | 18 (12.9) |
Intestinal metaplasia | |
Negative | 38 (27.1) |
Positive | 102 (72.9) |
Data are presented as mean±SD or number (%).
EGC, early gastric cancer; AGC, advanced gastric cancer.
Postoperative Endoscopic Follow-Up Sessions
No. of follow-up times | No. (%) |
---|---|
Up to 1st time | 96 (68.6) |
Up to 2nd time | 19 (13.6) |
Up to 3rd–7th time | 25 (17.9) |
Comparison of Persistently
Variable | Negative conversion* (n=60) | Persistently positive (n=80) | p-value |
---|---|---|---|
Surgery | 0.261 | ||
Subtotal B-I | 34 (56.7) | 57 (71.3) | |
Subtotal B-II | 20 (33.3) | 18 (22.5) | |
Subtotal Roux-en-Y | 2 (3.3) | 2 (2.5) | |
Subtotal with jejunal interposition | 0 | 1 (1.3) | |
Proximal gastrectomy | 4 (6.7) | 2 (2.5) | |
Age, yr | 58.95±11.09 | 59.09±11.93 | 0.944 |
Male sex | 36 (60.0) | 49 (61.3) | 1.000 |
Smoking | 0.168 | ||
Never | 22 (36.7) | 35 (43.8) | |
Current | 17 (28.3) | 12 (15.0) | |
Ex-smoker | 21 (35.0) | 33 (41.3) | |
Alcohol | 0.971 | ||
None | 30 (50.5) | 39 (48.8) | |
Social | 22 (36.7) | 31 (38.8) | |
Heavy | 8 (13.3) | 10 (12.5) | |
Atrophic gastritis (baseline) | 0.677 | ||
Negative | 16 (26.7) | 18 (22.5) | |
Positive | 38 (63.3) | 50 (62.5) | |
Inapplicable | 6 (10.0) | 12 (15.0) | |
Atrophic gastritis (1st follow-up) | 0.008† | ||
Negative | 32 (53.3) | 36 (45.0) | |
Positive | 8 (13.3) | 20 (25.0) | |
Inapplicable | 20 (33.3) | 16 (20.0) | |
Not available | 0 | 8 (10.0) | |
Intestinal metaplasia (baseline) | 0.340 | ||
Negative | 19 (31.7) | 19 (23.8) | |
Positive | 41 (68.3) | 61 (76.3) | |
Intestinal metaplasia (1st follow-up) | 0.001† | ||
Negative | 38 (63.3) | 59 (73.8) | |
Positive | 22 (36.7) | 13 (16.3) | |
Not available | 0 | 8 (10.0) |
Data are presented as number (%) or mean±SD.
†Statistically significant correlations (p<0.05).
Gut and Liver 2017; 11(2): 209-215
Published online March 15, 2017 https://doi.org/10.5009/gnl16224
Copyright © Gut and Liver.
Kichul Yoon1,2, Nayoung Kim1,3, Jaeyeon Kim3, Jung Won Lee3, Hye Seung Lee4, Jong-Chan Lee1, Hyuk Yoon1, Cheol Min Shin1, Young Soo Park1, Sang-Hoon Ahn5, Do Joong Park5, Hyung Ho Kim5, Yoon Jin Lee6, Kyoung-Ho Lee6, Young-Hoon Kim6, Dong Ho Lee1,3
1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, 2Department of Internal Medicine, Seoul Adventist Hospital, Seoul, Korea, 3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea, 4Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea, 5Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, 6Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
Correspondence to:Nayoung Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173beon-gil, Bundang-gu, Seongnam 13620, Korea, Tel: +82-31-787-7008, Fax: +82-31-787-4051, E-mail: nayoungkim49@empas.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Patients who underwent curative gastrectomy at Seoul National University Bundang Hospital and had a positive One hundred forty patients (mean age, 59.0 years; 60.7% male) underwent subtotal gastrectomy with B-I (65.0%), B-II (27.1%), Roux-en-Y (4.3%), jejunal interposition (0.7%), or proximal gastrectomy (4.3%). Preoperative presence of AG (62.9%) and IM (72.9%) was confirmed. The mean period between surgery and the last endoscopic follow-up was 38.0±25.6 months. Of the 140 patients, 80 (57.1%) were found to be persistently positive for A high percentage of spontaneous regression and complex dynamic changes in Background/Aims
Methods
Results
Conclusions
Keywords:
Gastric cancer had been the most common cause of cancer deaths worldwide until the 1990s.1 Although decreasing trends in incidence and mortality rates have been observed, stomach cancer is still the second leading cause of cancer death worldwide.2,3 Chronic infection with
Asia-Pacific consensus guideline suggested that
From this background, the aim of the present study was to evaluate the postoperative changes of
Patients who underwent gastric cancer surgery at Seoul National University Bundang Hospital with positive
This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital and written informed consent was obtained from all participants (IRB number: B-1510/320-116).
Preoperatively, four biopsy specimens were obtained from the antrum and the mid body of the stomach, respectively. After surgery, three tissue samples from lesser curvature and greater curvature of remained body were biopsied. Both Campylobacter like organism (CLO) test and Giemsa stain were done on every patient pre- and postoperatively.
Tissue sections were stained with modified Giemsa to prove the presence of
The patients with persistent
All statistical analyses were performed using the SPSS software version 18.0 (SPSS Inc., Chicago, IL, USA). Student t-test and chi-square test were used to compare the baseline characteristics between persistently positive- and spontaneous negative conversion group. To assess the factors related with postoperative
A total of 140 biopsy proven stomach cancer patients (mean age, 59.0 years; 85 male [60.7%]) with known
All patients had undergone gastrectomy (subtotal gastrectomy with B-I, 91 [65.0%]; B-II, 38 [27.1%]; Roux-en-Y, 4 [4.3%]; jejunal interposition, 1 [0.7%]; proximal gastrectomy, 6 [4.3%]). There were 69 (49.3%) of intestinal and 69 (49.3%) of diffuse type cancers according to Lauren classification. Mean size of cancer lesion was 3.79±2.3 cm. Histologic AG and IM were confirmed to be present (AG, 88 [62.9%]; IM, 102 [72.9%]) before surgery.
After surgery, annual follow-up was planned, and all 140 patients underwent endoscopy at least once (up to seven times). Forty-four patients (31.5%) were followed up more than twice. The mean interval between surgery and the first follow-up was 25.3±19.8 months. Mean follow-up period between surgery and the last endoscopic follow up was 38.0±25.6 months (Table 2).
All patients had their
After surgery, 60 patients (42.9%) showed spontaneous
We compared variables between the patients who had persistent
The distribution for the presence of AG and IM was not different between two groups at the baseline biopsy. However, there were significant changes based on the first postoperative biopsy results (Table 3). Spontaneous negative conversion group showed trend of having more IM compared to the
It is controversial whether
In the present study, spontaneous negative conversion of
In our study, there was no significant difference between spontaneous conversion and persistently positive groups according to surgery type, which could affect the bile reflux. It could suggest that IM could be a more important factor for the survival of
As remnant stomach has different anatomic and biological environment, there have been several studies to investigate the efficacy of postoperative eradication therapy.11,24–27 However, the number of subjects in those studies was relatively small, and the time from the operation to the eradication therapy was too long. Moreover, eradication regimen in some studies is not applicable nowadays because PPI based dual therapy was used instead of PPI-based triple therapy in the earlier studies.24,25 In addition, it is sometimes difficult to interpret the eradication in the gastric remnant as dynamic changes frequently occur. Therefore, careful serial follow-up is necessary to define “true spontaneous regression.”
The present study is a comprehensive study with relatively long duration of follow-up around 3 years. It also confirmed
In conclusion, we observed that there was relatively high percentage of spontaneous regression and dynamic changes in status of
This work was supported by the Global Core Research Center (GCRC) grant (2011-0030001) from the National Research Foundation (NRF), Ministry of Education, Science and Technology (MEST), Republic of Korea.
Table 1 Baseline Characteristics of 140 Patients with Biopsy-Confirmed Stomach Cancer
Variable | Value |
---|---|
Age, yr | 59.0±11.54 |
Sex | |
Male | 85 (60.7) |
Female | 55 (39.3) |
Lauren classification | |
Intestinal | 69 (49.3) |
Diffuse | 69 (49.3) |
Mixed | 2 (1.4) |
EGC or AGC | |
EGC | 91 (65.0) |
AGC | 49 (35.0) |
Cancer location | |
Antrum | 63 (45.0) |
Body | 65 (46.4) |
Antrum and body | 7 (5.0) |
Cardia | 5 (3.6) |
Surgery type | |
Subtotal gastrectomy | |
Billroth I | 91 (65.0) |
Billroth II | 38 (27.1) |
Roux-en-Y | 4 (4.3) |
With jejunal interposition | 1 (0.7) |
Proximal gastrectomy | 6 (4.3) |
Smoking | |
Never | 57 (40.7) |
Current | 29 (20.7) |
Ex-smoker | 54 (38.6) |
Alcohol | |
None | 69 (49.3) |
Social | 53 (37.9) |
Heavy* | 18 (12.9) |
Atrophic gastritis | |
Negative | 34 (24.3) |
Positive | 88 (62.9) |
Not applicable | 18 (12.9) |
Intestinal metaplasia | |
Negative | 38 (27.1) |
Positive | 102 (72.9) |
Data are presented as mean±SD or number (%).
EGC, early gastric cancer; AGC, advanced gastric cancer.
Table 2 Postoperative Endoscopic Follow-Up Sessions
No. of follow-up times | No. (%) |
---|---|
Up to 1st time | 96 (68.6) |
Up to 2nd time | 19 (13.6) |
Up to 3rd–7th time | 25 (17.9) |
Mean period between surgery and the last endoscopic follow-up: 38.0±25.6 months.
Table 3 Comparison of Persistently
Variable | Negative conversion* (n=60) | Persistently positive (n=80) | p-value |
---|---|---|---|
Surgery | 0.261 | ||
Subtotal B-I | 34 (56.7) | 57 (71.3) | |
Subtotal B-II | 20 (33.3) | 18 (22.5) | |
Subtotal Roux-en-Y | 2 (3.3) | 2 (2.5) | |
Subtotal with jejunal interposition | 0 | 1 (1.3) | |
Proximal gastrectomy | 4 (6.7) | 2 (2.5) | |
Age, yr | 58.95±11.09 | 59.09±11.93 | 0.944 |
Male sex | 36 (60.0) | 49 (61.3) | 1.000 |
Smoking | 0.168 | ||
Never | 22 (36.7) | 35 (43.8) | |
Current | 17 (28.3) | 12 (15.0) | |
Ex-smoker | 21 (35.0) | 33 (41.3) | |
Alcohol | 0.971 | ||
None | 30 (50.5) | 39 (48.8) | |
Social | 22 (36.7) | 31 (38.8) | |
Heavy | 8 (13.3) | 10 (12.5) | |
Atrophic gastritis (baseline) | 0.677 | ||
Negative | 16 (26.7) | 18 (22.5) | |
Positive | 38 (63.3) | 50 (62.5) | |
Inapplicable | 6 (10.0) | 12 (15.0) | |
Atrophic gastritis (1st follow-up) | 0.008† | ||
Negative | 32 (53.3) | 36 (45.0) | |
Positive | 8 (13.3) | 20 (25.0) | |
Inapplicable | 20 (33.3) | 16 (20.0) | |
Not available | 0 | 8 (10.0) | |
Intestinal metaplasia (baseline) | 0.340 | ||
Negative | 19 (31.7) | 19 (23.8) | |
Positive | 41 (68.3) | 61 (76.3) | |
Intestinal metaplasia (1st follow-up) | 0.001† | ||
Negative | 38 (63.3) | 59 (73.8) | |
Positive | 22 (36.7) | 13 (16.3) | |
Not available | 0 | 8 (10.0) |
Data are presented as number (%) or mean±SD.
†Statistically significant correlations (p<0.05).