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Eradication of Helicobacter pylori (HP) has been widely performed, but subsequent upper gastrointestinal lesions associated with HP eradication have been reported. In this study, we investigated the frequency of upper intestinal lesions that developed after successful HP eradication and the course for five years after eradication. Subjects and methods: The subjects were 122 patients with HPpositive gastric ulcer or duodenal ulcer for whom successful eradication therapy with a proton pump inhibitor and antibiotics was performed. Patients did not receive medication after ulcer was healed, and the upper digestive tract was examined by endoscopy 3, 6, and 12 months after eradication and yearly for five years to investigate the development of lesions in the upper digestive tract. Results Duodenal erosion developed in the third month after eradication in 8.6% of the patients. Most of these patients had no subjective symptom and erosion resolved without treatment. Antral stomach erosion was observed in 12% in the third month after eradication. Antral stomach erosion was observed in 8.1% and 4.8% in the second and third year, but not in the fourth and fifth year. Most of these cases were not accompanied by symptoms. The frequency of gastroesophagial reflux disease was only 2.2% one year after eradication, but the frequency remained 2-4% even 2-5 years after eradication. Many cases were accompanied by symptoms. Despite successful eradication, stomach or duodenal ulcer recurred in 10 patients (8.2%) during the period from three months to five years after eradication. Two of 10 patients used NSAID, but the other 8 patients did not. Conclusion Long-term careful observation of ulcer patients is necessary to prevent recurrence of ulceration and development of duodenal erosion, antral gastritis, and gastroesophagial reflux disease, although HP eradication was successful. [ABSTRACT FROM AUTHOR]

Objective: Stenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results., Design: In a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours., Results: Overall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, p<0.01). Subgrouping was also relevant with respect to tumour ingrowth (lower with covered stents for intrinsic tumours; 1.6% vs 27.7%, p<0.01) and stent migration (higher with covered stents for extrinsic tumours: 15.3% vs 2.5%, p<0.01)., Conclusions: Due to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is a frequent adverse event after ESD. We aimed to develop and externally validate a clinically useful prediction model (BEST-J score: Bleeding after ESD Trend from Japan) for bleeding after ESD for EGC., Design: This retrospective study enrolled patients who underwent ESD for EGC. Patients in the derivation cohort (n=8291) were recruited from 25 institutions, and patients in the external validation cohort (n=2029) were recruited from eight institutions in other areas. In the derivation cohort, weighted points were assigned to predictors of bleeding determined in the multivariate logistic regression analysis and a prediction model was established. External validation of the model was conducted to analyse discrimination and calibration., Results: A prediction model comprised 10 variables (warfarin, direct oral anticoagulant, chronic kidney disease with haemodialysis, P2Y12 receptor antagonist, aspirin, cilostazol, tumour size >30 mm, lower-third in tumour location, presence of multiple tumours and interruption of each kind of antithrombotic agents). The rates of bleeding after ESD at low-risk (0 to 1 points), intermediate-risk (2 points), high-risk (3 to 4 points) and very high-risk (≥5 points) were 2.8%, 6.1%, 11.4% and 29.7%, respectively. In the external validation cohort, the model showed moderately good discrimination, with a c -statistic of 0.70 (95% CI, 0.64 to 0.76), and good calibration (calibration-in-the-large, 0.05; calibration slope, 1.01)., Conclusions: In this nationwide multicentre study, we derived and externally validated a prediction model for bleeding after ESD. This model may be a good clinical decision-making support tool for ESD in patients with EGC., Competing Interests: Competing interests: MF declared that he received lecture honoraria from Takeda Pharmaceutical, EA Pharma, Nihon Pharmaceutical and his department received research grants from HOYA Pentax, EA Pharma, Eisai, Taiho Phamaceutical, AbbVie GK, Nippon Kayaku, Chugai Pharmaceutical, Gilead Sciences, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma outside the submitted work., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)