The degree of mucosal atrophy is associated with post-endoscopic submucosal dissection bleeding in early gastric cancer

Yoshito Hayashi; Waku Hatta; Yosuke Tsuji; Toshiyuki Yoshio; Yohei Yabuuchi; Shu Hoteya; Shigetsugu Tsuji; Yasuaki Nagami; Takuto Hikichi; Masakuni Kobayashi; Yoshinori Morita; Tetsuya Sumiyoshi; Mikitaka Iguchi; Hideomi Tomida; Takuya Inoue; Tatsuya Mikami; Kenkei Hasatani; Jun Nishikawa; Tomoaki Matsumura; Hiroko Nebiki; Dai Nakamatsu; Ken Ohnita; Haruhisa Suzuki; Hiroya Ueyama; Mitsushige Sugimoto; Shinjiro Yamaguchi; Tomoki Michida; Tomoyuki Yada; Yoshiro Asahina; Toshiaki Narasaka; Shiko Kuribayashi; Shu Kiyotoki; Katsuhiro Mabe; Akimitsu Miyake; Mitsuhiro Fujishiro; Atsushi Masamune; Tetsuo Takehara

doi:10.1111/jgh.15793

The degree of mucosal atrophy is associated with post-endoscopic submucosal dissection bleeding in early gastric cancer

Yoshito Hayashi, Waku Hatta, Yosuke Tsuji, Toshiyuki Yoshio, Yohei Yabuuchi, Shu Hoteya, Shigetsugu Tsuji, Yasuaki Nagami, Takuto Hikichi, Masakuni Kobayashi, Yoshinori Morita, Tetsuya Sumiyoshi, Mikitaka Iguchi, Hideomi Tomida, Takuya Inoue, Tatsuya Mikami, Kenkei Hasatani, Jun Nishikawa, Tomoaki Matsumura, Hiroko NebikiDai Nakamatsu, Ken Ohnita, Haruhisa Suzuki, Hiroya Ueyama, Mitsushige Sugimoto, Shinjiro Yamaguchi, Tomoki Michida, Tomoyuki Yada, Yoshiro Asahina, Toshiaki Narasaka, Shiko Kuribayashi, Shu Kiyotoki, Katsuhiro Mabe, Akimitsu Miyake, Mitsuhiro Fujishiro, Atsushi Masamune, Tetsuo Takehara

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Background and Aim: Despite the widespread use of endoscopic submucosal dissection (ESD) for early gastric cancer, post-ESD bleeding remains a significant problem. Intragastric pH plays an important role in intragastric bleeding. Because gastric acid secretion contributes to intragastric pH, both the presence or absence of Helicobacter pylori infection and the degree of gastric mucosal atrophy may affect bleeding. The present study aimed to clarify the relationship between post-ESD bleeding and the degree of gastric mucosal atrophy based on H. pylori infection status. Methods: We included 8170 patients who underwent ESD for early gastric cancer at 33 hospitals in Japan from November 2013 to October 2016. We analyzed the risk factors contributing to post-ESD bleeding. Results: There were 3935 H. pylori-positive patients and 4235 H. pylori-negative patients. A nonsevere degree of gastric mucosal atrophy was an independent risk factor for post-ESD bleeding in H. pylori-negative patients (odds ratio: 1.51, P = 0.007), but not in H. pylori-positive patients (odds ratio: 0.91, P = 0.600). Further, in H. pylori-negative, but not H. pylori-positive, patients, the rate of post-ESD bleeding increased in a stepwise manner for patients continuing antithrombotic drug use, patients who withdrew antithrombotic drug use, and antithrombotic drug nonusers. Conclusions: Nonsevere gastric mucosal atrophy was a risk factor for post-ESD bleeding in early gastric cancer in H. pylori-negative patients but not in H. pylori-positive patients.

Original language	English
Pages (from-to)	870-877
Number of pages	8
Journal	Journal of Gastroenterology and Hepatology (Australia)
Volume	37
Issue number	5
DOIs	https://doi.org/10.1111/jgh.15793
Publication status	Published - 2022 May

Keywords

Helicobacter pylori
early gastric cancer
endoscopic submucosal dissection
gastric mucosal atrophy
post-ESD bleeding

ASJC Scopus subject areas

Hepatology
Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/jgh.15793

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Hayashi, Y., Hatta, W., Tsuji, Y., Yoshio, T., Yabuuchi, Y., Hoteya, S., Tsuji, S., Nagami, Y., Hikichi, T., Kobayashi, M., Morita, Y., Sumiyoshi, T., Iguchi, M., Tomida, H., Inoue, T., Mikami, T., Hasatani, K., Nishikawa, J., Matsumura, T., ... Takehara, T. (2022). The degree of mucosal atrophy is associated with post-endoscopic submucosal dissection bleeding in early gastric cancer. Journal of Gastroenterology and Hepatology (Australia), 37(5), 870-877. https://doi.org/10.1111/jgh.15793

Hayashi, Y, Hatta, W, Tsuji, Y, Yoshio, T, Yabuuchi, Y, Hoteya, S, Tsuji, S, Nagami, Y, Hikichi, T, Kobayashi, M, Morita, Y, Sumiyoshi, T, Iguchi, M, Tomida, H, Inoue, T, Mikami, T, Hasatani, K, Nishikawa, J, Matsumura, T, Nebiki, H, Nakamatsu, D, Ohnita, K, Suzuki, H, Ueyama, H, Sugimoto, M, Yamaguchi, S, Michida, T, Yada, T, Asahina, Y, Narasaka, T, Kuribayashi, S, Kiyotoki, S, Mabe, K, Miyake, A, Fujishiro, M, Masamune, A & Takehara, T 2022, 'The degree of mucosal atrophy is associated with post-endoscopic submucosal dissection bleeding in early gastric cancer', Journal of Gastroenterology and Hepatology (Australia), vol. 37, no. 5, pp. 870-877. https://doi.org/10.1111/jgh.15793

@article{38c59039f57249d4a2a7cca5df381938,

title = "The degree of mucosal atrophy is associated with post-endoscopic submucosal dissection bleeding in early gastric cancer",

abstract = "Background and Aim: Despite the widespread use of endoscopic submucosal dissection (ESD) for early gastric cancer, post-ESD bleeding remains a significant problem. Intragastric pH plays an important role in intragastric bleeding. Because gastric acid secretion contributes to intragastric pH, both the presence or absence of Helicobacter pylori infection and the degree of gastric mucosal atrophy may affect bleeding. The present study aimed to clarify the relationship between post-ESD bleeding and the degree of gastric mucosal atrophy based on H. pylori infection status. Methods: We included 8170 patients who underwent ESD for early gastric cancer at 33 hospitals in Japan from November 2013 to October 2016. We analyzed the risk factors contributing to post-ESD bleeding. Results: There were 3935 H. pylori-positive patients and 4235 H. pylori-negative patients. A nonsevere degree of gastric mucosal atrophy was an independent risk factor for post-ESD bleeding in H. pylori-negative patients (odds ratio: 1.51, P = 0.007), but not in H. pylori-positive patients (odds ratio: 0.91, P = 0.600). Further, in H. pylori-negative, but not H. pylori-positive, patients, the rate of post-ESD bleeding increased in a stepwise manner for patients continuing antithrombotic drug use, patients who withdrew antithrombotic drug use, and antithrombotic drug nonusers. Conclusions: Nonsevere gastric mucosal atrophy was a risk factor for post-ESD bleeding in early gastric cancer in H. pylori-negative patients but not in H. pylori-positive patients.",

keywords = "Helicobacter pylori, early gastric cancer, endoscopic submucosal dissection, gastric mucosal atrophy, post-ESD bleeding",

author = "Yoshito Hayashi and Waku Hatta and Yosuke Tsuji and Toshiyuki Yoshio and Yohei Yabuuchi and Shu Hoteya and Shigetsugu Tsuji and Yasuaki Nagami and Takuto Hikichi and Masakuni Kobayashi and Yoshinori Morita and Tetsuya Sumiyoshi and Mikitaka Iguchi and Hideomi Tomida and Takuya Inoue and Tatsuya Mikami and Kenkei Hasatani and Jun Nishikawa and Tomoaki Matsumura and Hiroko Nebiki and Dai Nakamatsu and Ken Ohnita and Haruhisa Suzuki and Hiroya Ueyama and Mitsushige Sugimoto and Shinjiro Yamaguchi and Tomoki Michida and Tomoyuki Yada and Yoshiro Asahina and Toshiaki Narasaka and Shiko Kuribayashi and Shu Kiyotoki and Katsuhiro Mabe and Akimitsu Miyake and Mitsuhiro Fujishiro and Atsushi Masamune and Tetsuo Takehara",

note = "Funding Information: We thank all collaborators in the Fight-Japan study group for the enrollment of patients and data collection: Naomi Kakushima and Hiroyuki Ono (Shizuoka Cancer Centre); Hiroyuki Odagiri (Toranomon Hospital); Kazuhiro Matsunaga and Shigenori Wakita (Ishikawa Prefectural Central Hospital); Masaki Ominami and Taishi Sakai (Osaka City University Graduate School of Medicine); Yuko Miura (The University of Tokyo); Minami Hashimoto, Jun Nakamura, and Ko Watanabe (Fukushima Medical University Hospital); Ryusuke Ariyoshi (Kobe University Graduate School of Medicine); Yutaka Okagawa, Takeyoshi Minagawa, and Ryoji Fujii (Tonan Hospital); Takao Maekita and Kazuhiro Fukatsu (Wakayama Medical University); Yoichi Hiasa (Ehime University Graduate School of Medicine); Daisuke Chinda, Hidezumi Kikuchi, and Tetsuya Tatsuta (Hirosaki University Hospital); Atsushi Goto (Yamaguchi University Graduate School of Medicine); Daisuke Maruoka, Kenichiro Okimoto, and Naoki Akizue (Chiba University Graduate School of Medicine); Tomoaki Yamasaki, Takehisa Suekane, and Yu Yasui (Osaka City General Hospital); Tsutomu Nishida and Masashi Yamamoto (Toyonaka Municipal Hospital); Keiichi Hashiguchi and Naoyuki Yamaguchi (Nagasaki University Hospital); Yoichi Akazawa and Hiroyuki Komori (Juntendo University School of Medicine); Yoshiki Tsujii and Hideki Iijima (Osaka University Graduate School of Medicine); Masaki Murata (Shiga University of Medical Science Hospital); Takashi Ohta (Kansai Rosai Hospital); Hidehiko Takabayashi (Saitama Medical Centre); Yoshiyuki Itakura (Kohnodai Hospital, National Centre for Global Health and Medicine); Kazuya Kitamura (Kanazawa University Hospital); Daisuke Akutsu (University of Tsukuba); and Toshio Uraoka (Gunma University Graduate School of Medicine). Funding Information: This study was partially supported by the Japanese Foundation for Research and Promotion of Endoscopy Grant. Financial support: Publisher Copyright: {\textcopyright} 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.",

year = "2022",

month = may,

doi = "10.1111/jgh.15793",

language = "English",

volume = "37",

pages = "870--877",

journal = "Journal of Gastroenterology and Hepatology (Australia)",

issn = "0815-9319",

publisher = "Wiley-Blackwell",

number = "5",

}

TY - JOUR

T1 - The degree of mucosal atrophy is associated with post-endoscopic submucosal dissection bleeding in early gastric cancer

AU - Hayashi, Yoshito

AU - Hatta, Waku

AU - Tsuji, Yosuke

AU - Yoshio, Toshiyuki

AU - Yabuuchi, Yohei

AU - Hoteya, Shu

AU - Tsuji, Shigetsugu

AU - Nagami, Yasuaki

AU - Hikichi, Takuto

AU - Kobayashi, Masakuni

AU - Morita, Yoshinori

AU - Sumiyoshi, Tetsuya

AU - Iguchi, Mikitaka

AU - Tomida, Hideomi

AU - Inoue, Takuya

AU - Mikami, Tatsuya

AU - Hasatani, Kenkei

AU - Nishikawa, Jun

AU - Matsumura, Tomoaki

AU - Nebiki, Hiroko

AU - Nakamatsu, Dai

AU - Ohnita, Ken

AU - Suzuki, Haruhisa

AU - Ueyama, Hiroya

AU - Sugimoto, Mitsushige

AU - Yamaguchi, Shinjiro

AU - Michida, Tomoki

AU - Yada, Tomoyuki

AU - Asahina, Yoshiro

AU - Narasaka, Toshiaki

AU - Kuribayashi, Shiko

AU - Kiyotoki, Shu

AU - Mabe, Katsuhiro

AU - Miyake, Akimitsu

AU - Fujishiro, Mitsuhiro

AU - Masamune, Atsushi

AU - Takehara, Tetsuo

N1 - Funding Information: We thank all collaborators in the Fight-Japan study group for the enrollment of patients and data collection: Naomi Kakushima and Hiroyuki Ono (Shizuoka Cancer Centre); Hiroyuki Odagiri (Toranomon Hospital); Kazuhiro Matsunaga and Shigenori Wakita (Ishikawa Prefectural Central Hospital); Masaki Ominami and Taishi Sakai (Osaka City University Graduate School of Medicine); Yuko Miura (The University of Tokyo); Minami Hashimoto, Jun Nakamura, and Ko Watanabe (Fukushima Medical University Hospital); Ryusuke Ariyoshi (Kobe University Graduate School of Medicine); Yutaka Okagawa, Takeyoshi Minagawa, and Ryoji Fujii (Tonan Hospital); Takao Maekita and Kazuhiro Fukatsu (Wakayama Medical University); Yoichi Hiasa (Ehime University Graduate School of Medicine); Daisuke Chinda, Hidezumi Kikuchi, and Tetsuya Tatsuta (Hirosaki University Hospital); Atsushi Goto (Yamaguchi University Graduate School of Medicine); Daisuke Maruoka, Kenichiro Okimoto, and Naoki Akizue (Chiba University Graduate School of Medicine); Tomoaki Yamasaki, Takehisa Suekane, and Yu Yasui (Osaka City General Hospital); Tsutomu Nishida and Masashi Yamamoto (Toyonaka Municipal Hospital); Keiichi Hashiguchi and Naoyuki Yamaguchi (Nagasaki University Hospital); Yoichi Akazawa and Hiroyuki Komori (Juntendo University School of Medicine); Yoshiki Tsujii and Hideki Iijima (Osaka University Graduate School of Medicine); Masaki Murata (Shiga University of Medical Science Hospital); Takashi Ohta (Kansai Rosai Hospital); Hidehiko Takabayashi (Saitama Medical Centre); Yoshiyuki Itakura (Kohnodai Hospital, National Centre for Global Health and Medicine); Kazuya Kitamura (Kanazawa University Hospital); Daisuke Akutsu (University of Tsukuba); and Toshio Uraoka (Gunma University Graduate School of Medicine). Funding Information: This study was partially supported by the Japanese Foundation for Research and Promotion of Endoscopy Grant. Financial support: Publisher Copyright: © 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

PY - 2022/5

Y1 - 2022/5

N2 - Background and Aim: Despite the widespread use of endoscopic submucosal dissection (ESD) for early gastric cancer, post-ESD bleeding remains a significant problem. Intragastric pH plays an important role in intragastric bleeding. Because gastric acid secretion contributes to intragastric pH, both the presence or absence of Helicobacter pylori infection and the degree of gastric mucosal atrophy may affect bleeding. The present study aimed to clarify the relationship between post-ESD bleeding and the degree of gastric mucosal atrophy based on H. pylori infection status. Methods: We included 8170 patients who underwent ESD for early gastric cancer at 33 hospitals in Japan from November 2013 to October 2016. We analyzed the risk factors contributing to post-ESD bleeding. Results: There were 3935 H. pylori-positive patients and 4235 H. pylori-negative patients. A nonsevere degree of gastric mucosal atrophy was an independent risk factor for post-ESD bleeding in H. pylori-negative patients (odds ratio: 1.51, P = 0.007), but not in H. pylori-positive patients (odds ratio: 0.91, P = 0.600). Further, in H. pylori-negative, but not H. pylori-positive, patients, the rate of post-ESD bleeding increased in a stepwise manner for patients continuing antithrombotic drug use, patients who withdrew antithrombotic drug use, and antithrombotic drug nonusers. Conclusions: Nonsevere gastric mucosal atrophy was a risk factor for post-ESD bleeding in early gastric cancer in H. pylori-negative patients but not in H. pylori-positive patients.

AB - Background and Aim: Despite the widespread use of endoscopic submucosal dissection (ESD) for early gastric cancer, post-ESD bleeding remains a significant problem. Intragastric pH plays an important role in intragastric bleeding. Because gastric acid secretion contributes to intragastric pH, both the presence or absence of Helicobacter pylori infection and the degree of gastric mucosal atrophy may affect bleeding. The present study aimed to clarify the relationship between post-ESD bleeding and the degree of gastric mucosal atrophy based on H. pylori infection status. Methods: We included 8170 patients who underwent ESD for early gastric cancer at 33 hospitals in Japan from November 2013 to October 2016. We analyzed the risk factors contributing to post-ESD bleeding. Results: There were 3935 H. pylori-positive patients and 4235 H. pylori-negative patients. A nonsevere degree of gastric mucosal atrophy was an independent risk factor for post-ESD bleeding in H. pylori-negative patients (odds ratio: 1.51, P = 0.007), but not in H. pylori-positive patients (odds ratio: 0.91, P = 0.600). Further, in H. pylori-negative, but not H. pylori-positive, patients, the rate of post-ESD bleeding increased in a stepwise manner for patients continuing antithrombotic drug use, patients who withdrew antithrombotic drug use, and antithrombotic drug nonusers. Conclusions: Nonsevere gastric mucosal atrophy was a risk factor for post-ESD bleeding in early gastric cancer in H. pylori-negative patients but not in H. pylori-positive patients.

KW - Helicobacter pylori

KW - early gastric cancer

KW - endoscopic submucosal dissection

KW - gastric mucosal atrophy

KW - post-ESD bleeding

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U2 - 10.1111/jgh.15793

DO - 10.1111/jgh.15793

M3 - Article

C2 - 35132695

AN - SCOPUS:85125809324

SN - 0815-9319

VL - 37

SP - 870

EP - 877

JO - Journal of Gastroenterology and Hepatology (Australia)

JF - Journal of Gastroenterology and Hepatology (Australia)

IS - 5

ER -

The degree of mucosal atrophy is associated with post-endoscopic submucosal dissection bleeding in early gastric cancer

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