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Background and Aims The effect of Helicobacter pylori eradication on de novo gastric cancer is controversial, although meta-analyses suggest a reduction in gastric cancer after eradication. The effect of high-density lipoprotein (HDL) on gastric cancer has been rarely reported. Methods In this large retrospective cohort study, participants underwent endoscopy and H pylori testing from 2003 to 2011 and underwent follow-up endoscopy and H pylori testing until 2013. H pylori infection was detected using a rapid urease test or histologic test. The H pylori eradication group was defined as successful eradication, whereas the H pylori persistent group was defined as noneradication or eradication failure. The risk of cancer was measured with hazard ratios (HRs) and 95% confidence intervals (CIs). Results Among 10,328 healthy subjects (5951 men; mean age, 48.7 years), 31 gastric cancers were detected during a median follow-up of 5.5 years. De novo gastric cancer developed in 21 of 3508 subjects (.6%) in the noneradication group, 4 of 2050 subjects (.2%) in the successful eradication group, and 6 of 4770 participants (.13%) in the absence of H pylori group. In the adjusted analysis, H pylori eradication decreased de novo gastric cancer risk (HR, .29; 95% CI, .10-.86) compared with the persistent group. The risk of de novo gastric cancer in absence of H pylori was also much lower compared with the persistent group (HR, .24; 95% CI, .09-.60). Low serum HDL increased the risk of de novo gastric cancer (HR, 2.67; 95% CI, 1.14-6.16). Conclusions Successful H pylori eradication reduced de novo gastric cancer, whereas low HDL increased its risk.

106 Background: The aim of this study is to compare the long-term outcomes between patients who underwent endoscopic submucosal dissection (ESD) and those who underwent surgery for early gastric cancers (EGCs) turned out to be out-of-indication of ESD. Methods: We retrospectively reviewed database on gastric cancer patient cohort who underwent ESD or surgery from 2004 to 2014. Patients whose lesions revealed to be out-of-indication for endoscopic resection after ESD or surgery were included in the analysis after 1:1 propensity score matching for baseline clinicopathologic characteristics. Overall survival (OS) and gastric cancer recurrence rates were compared between the matched ESD and surgery groups. Results: After propensity score matching, a total of 193 pairs of patients were included, and 126 pairs were ESD with additional operation group and 67 pairs were ESD without additional operation group. OS (5-year OS rates, 89.5% vs. 89.9%; P=.105) and gastric cancer recurrence rates (5-year recurrence rates, 2.6% vs. 1.6%; P=.080) were not different between the ESD and the matched surgery group. In the matched subgroups, ESD with additional operation group had comparable OS and gastric cancer recurrence rates in comparison with matched surgery group. However, ESD without additional operation group had significantly shorter OS (5-year OS rates, 76.8% vs. 86.3%; P=.032) and higher gastric cancer recurrence rates (5-year recurrence rates, 11.9% vs. 0%; P=.002) than matched surgery group. ESD without additional operation was also significant risk factor for overall mortality and gastric cancer recurrence in multivariate analyses. Conclusions: Patients who did not undergo additional operation after ESD for EGCs turned out be the out-of-indication had worse long-term outcomes. Additional operation should be recommended, when EGC was identified to be the out-of-indication after ESD.

Sa1549 Relationship Between Safety Horizontal Resection Margin and Locally Recurrent Early Gastric Cancer After Endoscopic Submucosal Dissection Seon A. Kim*, Young-IL Kim, Myeong-Cherl Kook, Jong Yeul Lee, Chan Gyoo Kim, IL Ju Choi Center for Gastric Cancer, National Cancer Center, Korea, Goyang, Korea (the Republic of) Background and Aims: A current treatment guideline for early gastric cancer (EGC) recommended that a gross safety margin of surgically resected specimen should be at least 2 cm. However, the safety resection margin for endoscopic submucosal dissection (ESD) is still unclear. The aim of this study was to investigate the association between the distance from horizontal margin (HM) and local recurrence after ESD in patients with EGC. Methods: We reviewed clinicopathologic data of patients who underwent ESD for EGC between September 2004 and December 2012 at the National Cancer Center, Korea. The local recurrence after ESD was investigated according to the distance from HM. Results: Among 1,064 patients who had no vertical margin involvement after ESD for EGC, median distance from HM was 7 mm. Of 80 patients (7.5%) with safety HM margin of less than 2 mm, 7 patients underwent additional argon plasma coagulation (APC). During follow-up after ESD, local recurrence occurred in 1 patient (1/80 patients, 1.3%). The locally recurred patient had positive HM on the initial ESD, but additional APC was not performed. EGC recurred at 33 months after ESD, and the tumor successfully treated by repeated ESD. On the contrary, all patients (985 patients, 92.5%) with the safety HM margin of R 2 mm did not undergo additional procedures, and there was no local recurrence during follow-up periods after ESD. Conclusions: In EGC patients who underwent ESD, the safety HM of resected specimen may be at least 2 mm without an additional procedure including APC.

Background EMR with circumferential mucosal incision facilitates en bloc resection, which is the most important predictor for complete resection in the treatment of intramucosal gastric neoplasm. The objective of the study was to evaluate the efficacy and the safety of EMR with circumferential mucosal incision in relation to the endoscopist's experience. Methods In this retrospective study, we analyzed the outcome of 80 EMR procedures performed by a single endoscopist at the National Cancer Center, Goyang, Korea. The EMR procedure with circumferential mucosal incision was performed with a conventional needle knife. We compared the en bloc resection rate, the complete resection rate, the duration of the procedure time, and the associated complications by quartiles. Results From the first to the last quartile, en bloc resection rates were 55%, 45%, 85%, and 85% (p = 0.006), and complete resection rates were 65%, 60%, 90%, and 85% (p = 0.039). The increase in the mean en bloc and complete resection rates between the first two quartiles and the second two quartiles was significant (p = 0.002 and p = 0.019, respectively). Three perforations (15%) were reported in the first quartile and only one (1.7%) in the remaining 3 quartiles (p = 0.046). The procedure time also decreased after the first 20 cases (p = 0.004). Conclusions For an experienced endoscopist, EMR with circumferential mucosal incision could be performed effectively and safely after the experience of 40 cases.

Background Endoscopic resection (ER) of early gastric cancer (EGC) meeting the absolute indication has excellent long-term outcomes. Objective To compare long-term outcomes of ER with those of surgery in patients with EGC who met the absolute indication for ER. Design Retrospective cohort study. Setting A specialized center for the treatment of cancer. Patients and Interventions We retrospectively reviewed data from patients who underwent gastrectomy or ER for EGC between 2002 and 2007. Gastric cancers were differentiated-type adenocarcinoma without ulceration confined to the mucosal layer and 2 cm or smaller in size. Main Outcome Measurements The primary outcome was overall survival (OS). Metachronous cancer rates and adverse event rates were compared. Kaplan-Meier plots and Cox proportional hazard regression analyses were applied for comparisons. Differences in baseline characteristics were adjusted by propensity score. Results Among 375 patients, 261 underwent ER and 114 underwent surgery. The median follow-up duration was 76.4 months. The 5-year OS rates did not significantly differ between the ER and surgery groups (95.7% vs 93.6%, respectively; P = .725 by log-rank test). There were no gastric cancer–related deaths in either group. Metachronous gastric cancer developed more frequently in the ER group (6.1%, 16/261) than in the surgery group (0.9%, 1/114) ( P = .024). However, most patients (93.8%, 15/16) in the ER group were curatively treated with repeat ER. Adverse event rates were higher in the surgery group than those in the ER group (7.9% vs 2.7%, P = .028). Limitations Retrospective, single-center study. Conclusions The OS rate after ER for mucosal gastric cancer that met the absolute indication was comparable to that achieved with surgery. Although metachronous cancers were more common after ER, they were usually treatable and did not affect survival.

Routine Follow-up Biopsies to Detect Local Recurrence After Complete Endoscopic Resection for Early Gastric Cancer May Be Unnecessary Jong Yeul Lee*, IL Ju Choi, Soo-Jeong Cho, Chan Gyoo Kim, Myeong-Cherl Kook, Jun Ho Lee, Keun Won Ryu, Young-Woo Kim Center for Gastric Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea Background and study aims: Local recurrence due to residual tumor may occur at the endoscopic resection (ER) site after ER for early gastric cancer (EGC). The aims of this study were to evaluate the predictive factors for local recurrence and suggest an appropriate follow-up biopsy strategy. Patients and methods: We retrospectively reviewed 396 EGCs from 372 consecutive patients who underwent ER between January 2002 and April 2008. Cumulative recurrence rate were determined by the Kaplan-Meier method and Cox proportional hazards analysis was used to determine the risk factors for local recurrence. Results: Local recurrence at ER site was found in 17 cases among 396 lesions during a median follow-up period of 48 months. The 5-year cumulative local recurrence rate was 4.8%. Multivariate analyses determined that tumor involvement at the lateral resection margin [hazard ratio (HR): 35.9; P 0.001], an uncheckable lateral resection margin [HR: 16.8; P 0.001], an uncheckable or involved deep resection margin [HR: 3.76; P 0.047], and a piecemeal resection [HR: 3.95; P 0.007] were associated with local recurrence. If a lesion was positive for any of these risk factors, the 5-year cumulative recurrence rate was 27.0%, while local recurrence was not found in any lesion that lacked these risk factors. Most episodes of recurrence were found during the first or second follow-up endoscopic biopsy at the ulcer scar. Conclusions: Routine follow-up biopsies at the ER site might be unnecessary in cases where an EGC lesion was endoscopically resected en bloc with tumor-free lateral and deep margins.