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Abstract
Background Endoscopic submucosal dissection (ESD) is commonly used to treat early gastric cancer (EGC). The effects of Helicobacter pylori (HP) infection on ESD and the potential benefits of preoperative eradication of HP are unclear. We aimed to study the impact of HP infection on bleeding and lesion detection during ESD in these patients.
Methods A total of 634 consecutive patients who underwent ESD for EGC at our centre from January 2018 to January 2023 were enrolled retrospectively. Logistic regression was used to analyze intraoperative bleeding and lesion detection rate based on HP eradication status. The screened indicators were used to create a predictive model, and efficacy was assessed using the ROC curve.
Results HP-positive patients had a higher intraoperative bleeding rate (28.8%) compared with Hp-negative patients (8.9%) (P<0.001). HP-positive patients also had longer procedure time (median: 58.5 vs 50.0 minutes, P<0.001) and postoperative hospital stay (median: 4.35 vs 4.07 days, P=0.036) compared to HP-negative patients. Multivariate analysis revealed that HP-positive (OR=4.84), multiple lesions (OR=1.81), specimen size > 40 mm (OR=3.67), and submucosal invasion (OR=2.27) were independent risk factors for intraoperative bleeding (IDDF2024-ABS-0046 Figure 1). The predictive model had an AUC of 0.807 (95%CI=0.761-0.852) with a sensitivity of 72.1% and a specificity of 75.9% (IDDF2024-ABS-0046 Figure 2). Eradicating HP also increased the rate of lesion detection independently (OR=2.82).
Conclusions HP eradication before ESD in patients with EGC reduces intraoperative bleeding and improves lesion detection. It is very necessary to eradicate HP before ESD for patients with EGC.