Title: The Influence of H pylori Infection on the Healing Process of Gastric Ulcers After Endoscopic Submucosal Dissection
Abstract: Background & Aim: FEndoscopic submucosal dissection (ESD) is rapidly becoming popular for treatment of mucosal tumors in the GI tract, especially for larger lesions difficult for conventional EMR. We have previously reported that gastric artificial ulcers after ESD would heal within 8 weeks regardless of size and its location, if there is no preoperative fibrosis under the lesion. In this study, we examined the influence of Helicobacter Pylori (HP) infection on the healing process of gastric ulcers after ESD. Method: From 2000 to 2003, 79 patients (male 65, female 14) who underwent ESD for mucosal tumors, and of which infectious state of HP was confirmed either pathologically or serologically, were included. The healing stage, pattern of scar formation was studied at follow up endoscopy performed within 6 to 8 weeks after the treatment. Normal doses of PPI and sucralfate were given for 8 weeks for postoperative medication. In addition, patients whose serum pepsinogen (PG) was evaluated before treatment (66 patients), were divided in 3 groups; PG positive (PG I < 70 and I/II < 3), strongly positive (PG < 30 and I/II < 2) and negative, according to Miki et al, to study the influence of atrophic gastritis on ulcer healing. Result: The average specimen size removed by ESD was 34 mm (range 20 to 90 mm). In 60 cases (76%), the ulcer contracted in the short axis (axial direction) of the stomach, resulting in linear scars along the long axis (sagittal direction). In 19 cases (24%), the ulcer contracted nearly in a concentric form, resulting in an asteroid scar. In 5 patients, a small mucosal defect was still observed at follow up, of which ulcerative findings were present before treatment. Infection of HP was positive in 68 patients, negative in 11 patients (previously eradicated 3, negative with atrophic gastritis 7, negative without atrophic gastritis 1). There were no significant difference in the healing stage or scar formation regarding HP infection state. Patients of PG positive, strongly positive and negative were 36, 15 and 15 patients, respectively. There were no significant difference among the 3 groups. Conclusion: Infection of HP or the degree of atrophic gastritis have no influence on the healing process of gastric ulcers after ESD.