Risk factors for recurrence of artificial gastric ulcers after endoscopic submucosal dissection

It has been reported previously that artificial gastric ulcers caused by endoscopic submucosal dissection (ESD) would heal within 8 weeks, irrespective of their size and location. The aim of this retrospective study was to describe long-term outcomes of gastric ESD ulcers. Check-up of ulcers was performed by periodic endoscopy. The rate of ESD ulcer recurrence and clinicopathological factors that may relate to recurrence were assessed. During the median observation period of 33 months, a benign ulcer recurrence occurred in 10 lesions in 10 patients (2.1 %). Univariate analysis showed that Helicobacter pylori infection and presence of pathological ulcer findings within the ESD specimen were significantly related to the risk of ESD ulcer recurrence. Although the frequency is low, there is a possibility of ESD ulcer recurrence in patients with H. pylori infection and in patients who undergo ESD for a lesion with ulceration.

References

• 1 Gotoda T, Yanagisawa A, Sasako M et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.  Gastric Cancer. 2000;  3 219-225
• 2 Oda I, Gotoda T, Hamanaka H et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series.  Dig Endosc. 2005;  17 54-58
• 3 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 225-229
• 4 Kakushima N, Fujishiro M, Yahagi N et al. The healing process of gastric artificial ulcers after endoscopic submucosal dissection.  Dig Endosc. 2004;  16 327-331
• 5 Hashimoto T, Adachi K, Fukumoto S et al. Changes in gastric mucosal blood flow during healing of EMR-induced ulcer – comparison with peptic ulcer.  Dig Endosc. 1997;  9 127-131
• 6 Ono H, Hasuike N, Inui T et al. Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer.  Gastric Cancer. 2008;  11 47-52
• 7 Ashton-Key M, Diss T C, Isaacson P G. Detection of Helicobacter pylori in gastric biopsy and resection specimens.  J Clin Pathol. 1996;  49 107-111
• 8 Nomura A, Stemmermann G N, Chyou P H et al. Helicobacter pylori infection and the risk for duodenal and gastric ulceration.  Ann Intern Med. 1994;  120 977-981
• 9 Kakushima N, Fujishiro M, Yahagi N et al. Helicobacter pylori status and the extent of gastric atrophy do not affect ulcer healing after endoscopic submucosal dissection.  J Gastroenterol Hepatol. 2006;  21 1586-1589
• 10 Kakushima N, Fujishiro M, Kodashima S et al. Histopathologic characteristics of gastric ulcers created by endoscopic submucosal dissection.  Endoscopy. 2006;  38 412-415