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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (15 September 2024) | Viewed by 12635

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Dr. Kazuhiro Mizukami

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Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu 879-5593, Japan
Interests: Helicobacter pylori; gastric cancer; endoscopic procedure; capsule endoscopy; image enhancement endoscopy; gastroesophageal reflux disease; anisakidosis
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Dear Colleagues,

Gastric cancer is the third common cancer in cancer deaths worldwide. However, it has undergone revolutionary changes in recent years with the establishment of early detection and diagnosis, early treatment, and preventive medicine. With regard to diagnosis, the remarkable development of diagnosis with image enhancement endoscopy and magnified endoscopy has made it possible to detect early gastric cancer. In addition, the emergence of artificial intelligence has the potential to change endoscopic diagnosis in the future. In terms of treatment, minimally invasive treatment including endoscopic treatment, such as endoscopic submucosal dissection (ESD), is attracting attention. With regard to prevention, Helicobacter pylori eradication is still the most important factor. Recently, it has been interesting to observe better eradication regimens, and third-line eradication therapy for unsuccessful cases. Data from medical checks and screening are also important because the early detection of gastric cancer clearly improves the prognosis of patients. With the spread of eradication therapy, it is also necessary to establish new cancer concepts, such as post-eradication gastric cancer and uninfected gastric cancer, and the topic of gastric cancer remains controversial.

In this Special Issue, we welcome submissions of papers on topics surrounding the diagnosis, treatment, and prevention of gastric cancer.

Dr. Kazuhiro Mizukami
Guest Editor

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Keywords

gastric cancer
diagnosis
treatment
prevention
IEE
ESD
Helicobacter pylori

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Published Papers (9 papers)

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12 pages, 3677 KiB

Open AccessArticle

Gender Differences in Patients with Gastric Adenocarcinoma

by Yujin Xing, Hiroko Hosaka, Fumitaka Moki, Shota Tomaru, Yuki Itoi, Keigo Sato, Yu Hashimoto, Hirohito Tanaka, Shiko Kuribayashi, Yoji Takeuchi, Kazue Nagai and Toshio Uraoka

J. Clin. Med. 2024, 13(9), 2524; https://doi.org/10.3390/jcm13092524 - 25 Apr 2024

Cited by 2 | Viewed by 1219

Abstract

Background: Gastric cancer (GC) epidemiology and outcomes vary by gender. Methods: We reviewed 18,436 GC patients from 2008 to 2018 and looked for gender differences in clinical characteristics and survival. Results: The gender proportion was 71% male and 29% female. Males had a significantly (p < 0.001) higher proportion of differentiated GC (66.3%) and a lower proportion of undifferentiated GC (26.3%). Diagnosis through medical check-ups was more common in males (30.0% vs. 26.4%, p < 0.001). Clinical staging revealed 54.6% of males and 52.9% of females had localized disease without lymph node metastasis (LNM), while distant metastasis occurred in 17.4% of males and 16.9% of females (p < 0.001). Kaplan–Meier survival curves indicated females had a significantly higher overall survival (p = 0.0018). The survival advantage for females was evident in the early stages, with a significant difference in localized disease without LNM (p < 0.001) and localized disease with LNM (p = 0.0026, log-rank test) but not in the advanced stages. Multivariate Cox regression analysis showed a significantly reduced mortality risk in females (p < 0.001). Conclusions: Significant gender differences exist with regard to pathological type, presentation, clinical stage, and overall survival. These findings suggest gender-specific strategies for screening, diagnosis, and treatment. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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10 pages, 382 KiB

Open AccessArticle

A Prospective Observational Study on Gastric Endoscopic Submucosal Dissection under Continuous Administration of Antithrombotic Agents

by Daisuke Kawai, Masaya Iwamuro, Ryuta Takenaka, Taisuke Obata, Takashi Yamamoto, Shoichiro Hirata, Ko Miura, Koji Takemoto, Hirofumi Tsugeno and Shigeatsu Fujiki

J. Clin. Med. 2024, 13(7), 1886; https://doi.org/10.3390/jcm13071886 - 25 Mar 2024

Viewed by 835

Abstract

Background: This study aimed to assess the completion rate and postoperative bleeding incidence of endoscopic submucosal dissection (ESD) for gastric tumors under continuous antithrombotic therapy. Methods: A prospective observational study was conducted including 88 patients with 100 gastric lesions who underwent gastric endoscopic submucosal dissection (ESD) and received continuous antithrombotic therapy. Additionally, retrospective data on gastric ESD in 479 patients with 534 lesions who did not receive antithrombotic therapy were collected for comparison. Results: The en bloc resection rates (100% in the continuous antithrombotic therapy group vs. 100% in the non-antithrombotic therapy group) and complete resection rates (97.0% vs. 96.3%, respectively) were high and comparable between the groups. No significant differences were found in the specimen size or procedure time. Perforation rates were low (0% vs. 2.3%, respectively) and were not significantly different between the groups. However, postoperative bleeding occurred significantly more frequently in the continuous antithrombotic therapy group (10.2% vs. 4.2%, respectively) than in the non-antithrombotic therapy group. The subgroup analysis revealed a higher incidence of postoperative bleeding in patients receiving thienopyridine derivatives. Conclusions: Continuous administration of antithrombotic agents, especially thienopyridines, increased the risk of postprocedural hemorrhage following gastric ESD. These findings support the need for careful consideration of pharamcological management before ESD, aligning with the current guidelines. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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12 pages, 2506 KiB

Open AccessArticle

Trends of Early Helicobacter pylori-Uninfected Gastric Cancer in an Aging Regional Area

by Hidehito Maeda, Fumisato Sasaki, Takayuki Ooi, Shohei Uehara, Hiroki Yano, Yoichi Sameshima, Yoshio Fukuda, Yuichiro Nasu, Yusuke Fujino, Koichiro Shigeta, Hiroshi Fujita, Akihito Tanaka, Shuji Kanmura and Akio Ido

J. Clin. Med. 2024, 13(6), 1827; https://doi.org/10.3390/jcm13061827 - 21 Mar 2024

Viewed by 1266

Abstract

Background/Objectives: We aimed to determine the trends over time and current status of early Helicobacter pylori-uninfected gastric cancer (HpUIGC) treatment in a region with an aging population. Methods: This retrospective, multi-center observational study was conducted at seven major general hospitals in Kagoshima Prefecture. From January 2009 to July 2022, 2091 patients who received endoscopic resection (ER) for early gastric cancer (EGC) were retrospectively enrolled, of which 35 were identified as early HpUIGC cases. Results: The number of ERs for EGC demonstrated a significant increasing trend from 2010 to 2021 (p = 0.01 for trend). Furthermore, the 12-year period from 2010 to 2021 was divided into an early and late phase every 6 years. In the early phase, there were 5 cases (0.7%) of early HpUIGC, while in the late phase, there were 25 cases (2.1%), indicating a significant increase in the proportion of ERs for early HpUIGC cases in the late phase (p = 0.02). Conclusions: The proportion of ERs for early HpUIGC, which are more common in relatively young patients, may be increasing as a proportion of all ERs for GC, even in areas of Japan with an aging population. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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10 pages, 357 KiB

Open AccessArticle

Characteristics and Risk Factors of Delayed Perforation in Endoscopic Submucosal Dissection for Early Gastric Cancer

by Taro Akashi, Naoyuki Yamaguchi, Junya Shiota, Maiko Tabuchi, Moto Kitayama, Keiichi Hashiguchi, Kayoko Matsushima, Yuko Akazawa and Kazuhiko Nakao

J. Clin. Med. 2024, 13(5), 1317; https://doi.org/10.3390/jcm13051317 - 26 Feb 2024

Cited by 1 | Viewed by 1159

Abstract

(1) Background: Delayed perforation after gastric endoscopic submucosal dissection (ESD) for early gastric cancer is a relatively uncommon and serious complication that sometimes requires emergency surgery. This study aimed to determine the clinicopathological features, risk factors, and appropriate management strategies for delayed perforation. (2) Methods: This study included 735 patients with 791 lesions who underwent ESD for early gastric cancer at a single institution between July 2009 and June 2019. We retrospectively compared the clinical features of patients with and without delayed perforations. (3) Results: The incidence of delayed perforations was 0.91%. The identified risk factors included a postoperative stomach condition and histopathological ulceration. A comparison between delayed and intraoperative perforations revealed a postoperative stomach condition as a characteristic risk factor for delayed perforation. Patients with delayed perforation who avoided emergency surgery tended to exhibit an earlier onset of symptoms such as abdominal pain and fever. No peritoneal seeding following delayed perforation was observed for any patient. (4) Conclusions: A postoperative stomach condition and histopathological ulceration were risk factors for delayed perforation. Delayed perforation is a significant complication that requires careful monitoring after gastric ESD for early gastric cancer, particularly in patients with postoperative gastric conditions. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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13 pages, 797 KiB

Open AccessArticle

The Efficacy and Safety of Nivolumab Plus mFOLFOX6 in Gastric Cancer with Severe Peritoneal Metastasis

by Yurika Nakayama, Takayuki Ando, Naoki Takahashi, Kenichiro Tsukada, Hiroaki Takagi, Yuno Goto, Atsuko Nakaya, Naokatsu Nakada, Hiroki Yoshita, Iori Motoo, Akira Ueda, Yuko Ueda, Miho Sakumura, Shinya Kajiura, Kohei Ogawa, Ayumu Hosokawa and Ichiro Yasuda

J. Clin. Med. 2024, 13(3), 834; https://doi.org/10.3390/jcm13030834 - 31 Jan 2024

Cited by 1 | Viewed by 1557

Abstract

(1) Background: Nivolumab plus chemotherapy is established as a first-line treatment for advanced gastric cancer (AGC). While mFOLFOX6 is commonly used for AGC with severe peritoneal metastasis, the efficacy of nivolumab combined with it remains uncertain. We evaluated the outcomes of nivolumab plus mFOLFOX6 for AGC with severe peritoneal metastasis in clinical practice. (2) Methods: This multicenter retrospective study was conducted between December 2021 and June 2023. We investigated AGC patients with massive ascites or inadequate oral intake due to severe peritoneal metastasis and who received nivolumab plus mFOLFOX6. (3) Results: Among 106 patients treated with nivolumab plus chemotherapy, 21 (19.8%) had severe peritoneal metastasis, with 14 receiving nivolumab plus mFOLFOX6. The median progression-free survival was 7.4 months (95%CI 1.9-10.1), and the median overall survival was 10.7 months (95%CI 5.3-NA), with four patients (28.5%) surviving more than 12 months. Improved ascites and oral intake were observed in 6/14 patients (42.8%) and 10/11 patients (90.9%), respectively. The major grade 3 or more adverse events included leukopenia (28.5%) and neutropenia (21.4%), with no severe immune-related adverse events reported. (4) Conclusions: The safety and moderate efficacy of nivolumab plus mFOLFOX6 were suggested even in AGC patients with severe peritoneal metastasis. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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12 pages, 1401 KiB

Open AccessArticle

Assessing the Influence of the COVID-19 Pandemic on Gastric Cancer Mortality Risk

by Yuya Shigenobu, Daisuke Miyamori, Kotaro Ikeda, Shuhei Yoshida, Yuka Kikuchi, Keishi Kanno, Saori Kashima and Masanori Ito

J. Clin. Med. 2024, 13(3), 715; https://doi.org/10.3390/jcm13030715 - 26 Jan 2024

Cited by 1 | Viewed by 1251

Abstract

Background: The global impact of the coronavirus disease 2019 (COVID-19) pandemic on public health has been significant. Upper gastrointestinal endoscopy for screening and diagnosis decreased along with new gastric cancer (GC) diagnoses. Methods: This study assesses how the pandemic affected GC mortality using data from Hiroshima Prefecture, comparing mortality rates between patients diagnosed during the pandemic (2020 and 2021) and pre-pandemic (2018 and 2019) periods. The crude hazard ratios (HRs) and HRs adjusted for age, sex, clinical stage, treatment status, and travel distance to the nearest GC screening facility were estimated using Cox regression models. Subgroup and sensitivity analyses were also performed. Results: A total of 9571 patients were diagnosed, with 4877 eligible for follow-up. The median age was 74 years, and 69% were male. The median follow-up period was 157 days, with events per 1000 person-years at 278 and 374 in the pre-pandemic and pandemic periods, respectively (crude HR, 1.37; adjusted HR, 1.17). The sensitivity and subgroup analyses yielded consistent results. Conclusions: The COVID-19 pandemic increased mortality risk in patients with GC. Further studies are required to observe long-term outcomes and identify the disparities contributing to the increased mortality risk. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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14 pages, 5792 KiB

Open AccessArticle

Endoscopic Diagnosis Strategy of Raspberry-Shaped Gastric Lesion in Helicobacter Pylori-Uninfected Patient

by Nobuyuki Suzuki, Atsushi Ikeda, Hiroya Ueyama, Noboru Yatagai, Yasuko Uemura, Momoko Yamamoto, Tomoyo Iwano, Hisanori Utsunomiya, Ryota Uchida, Daiki Abe, Shotaro Oki, Yoichi Akazawa, Tsutomu Takeda, Kumiko Ueda, Mariko Hojo, Takashi Yao and Akihito Nagahara

J. Clin. Med. 2023, 12(17), 5437; https://doi.org/10.3390/jcm12175437 - 22 Aug 2023

Cited by 1 | Viewed by 1585

Abstract

Objectives: We aimed to clarify the endoscopic and clinicopathological features of raspberry-shaped gastric lesions (RSGLs) and to establish an endoscopic diagnostic algorithm for RSGLs. Methods: We collected RSGLs from an endoscopic database at our hospital between May 2009 and August 2021. All RSGLs were histopathologically classified and compared based on their endoscopic and clinicopathological characteristics. Results: Sixty-five RSGLs in 54 patients were classified into five histopathological types: gastric adenocarcinoma of foveolar type (GA-FV, n = 43), gastric adenocarcinoma of fundic-gland type (GA-FG, n = 2), gastric adenocarcinoma of fundic-gland mucosa type (GA-FGM, n = 4), hyperplastic polyp (HP, n = 12), and proton pump inhibitor-related lesion (PPI-L, n = 4). All RSGLs exhibited polygonal or curved marginal crypt epithelium (MCE). GA-FV lesions had homogenously reddish (95%) and an irregular microvascular (MV) pattern (91%). GA-FG lesions were heterogeneously reddish with a submucosal tumor shape (100%) and had a regular MV pattern (50%). GA-FGM lesions were homogen+ously reddish (75%) and occasionally had a submucosal tumor shape (50%) with an irregular MV pattern (75%). HPs and PPI-Ls were homogeneously reddish (93%), with linear or dotted MCE (81%) and a regular MV pattern (100%). Conclusion: Our diagnostic algorithm for RSGLs constructed using endoscopic features might be useful for the endoscopic differential diagnosis of RSGLs. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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12 pages, 929 KiB

Open AccessFeature PaperArticle

ATG16L1 and ATG12 Gene Polymorphisms Are Involved in the Progression of Atrophic Gastritis

by Naoyuki Yamaguchi, Takuki Sakaguchi, Hajime Isomoto, Tatsuo Inamine, Haruka Ueda, Daisuke Fukuda, Ken Ohnita, Tsutomu Kanda, Hiroki Kurumi, Kayoko Matsushima, Tatsuro Hirayama, Kazuo Yashima and Kazuhiro Tsukamoto

J. Clin. Med. 2023, 12(16), 5384; https://doi.org/10.3390/jcm12165384 - 19 Aug 2023

Cited by 3 | Viewed by 1378

Abstract

Helicobacter pylori (H. pylori) infection causes a progression to atrophic gastritis and results in gastric cancer. Cytotoxin-associated gene A (CagA), a major virulence factor of H. pylori, is injected into gastric epithelial cells using the type IV secretion system. On the other hand, gastric epithelial cells degrade CagA using an autophagy system, which is strictly regulated by the autophagy-related (ATG) genes. This study aimed to identify SNPs in ATG5, ATG10, ATG12, and ATG16L1 associated with gastric mucosal atrophy (GMA). Here, two-hundred H. pylori-positive participants without gastric cancer were included. The degree of GMA was evaluated via the pepsinogen method. Twenty-five SNPs located in the four candidate genes were selected as tag SNPs. The frequency of each SNP between the GMA and the non-GMA group was evaluated. The rs6431655, rs6431659, and rs4663136 in ATG16L1 and rs26537 in ATG12 were independently associated with GMA. Of these four SNPs, the G/G genotype of rs6431659 in ATG16L1 has the highest odd ratio (Odds ratio = 3.835, 95% confidence intervals = 1.337–1.005, p = 0.008). Further functional analyses and prospective analyses with a larger sample size are required. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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12 pages, 500 KiB

Open AccessSystematic Review

Multivisceral Resection for Locally Advanced Gastric Cancer: A Systematic Review and Evidence Quality Assessment

by Dimitrios Schizas, Ilias Giannakodimos, Konstantinos S. Mylonas, Emmanouil I. Kapetanakis, Alexandra Papavgeri, Georgios D. Lianos, Dionysios Dellaportas, Aikaterini Mastoraki and Andreas Alexandrou

J. Clin. Med. 2023, 12(23), 7360; https://doi.org/10.3390/jcm12237360 - 28 Nov 2023

Cited by 2 | Viewed by 1437

Abstract

Patients with locally advanced gastric cancer (LAGC) often require multivisceral resection (MVR) of the involved organs to achieve R0 resection and local disease control. The aim of the present study was to systematically review all available literature on the postoperative and long-term outcomes of MVR for gastric cancer. The PubMed database was systematically searched by two independent investigators for studies concerning MVR for LAGC. In total, 30 original studies with 3362 patients met our inclusion criteria. R0 resection was achieved in 67.77% (95% CI, 65.75–69.73%) of patients. The spleen, colon and pancreas comprised the most frequently resected organs in the context of MVR. Pancreatic fistulae (10.08%, 95% CI, 7.99–12.63%), intraabdominal abscesses (9.92%, 95% CI, 7.85–12.46%) and anastomotic leaks (8.09%, 95% CI, 6.23–10.45%) constituted the most common postoperative complications. Using the available data, we estimated the mean 1-year survival at 62.2%, 3-year survival at 33.05%, and 5-year survival at 30.21% for the entire cohort. The survival rates were mainly correlated with lymphatic invasion, tumor size and patient age. Therefore, gastrectomy, together with MVR, is feasible and may offer a survival advantage compared to gastrectomy alone or no other surgical treatment in a selected group of patients. Consequently, both patient and tumor characteristics should be carefully assessed to optimize candidate selection. Full article

(This article belongs to the Special Issue Gastric Cancer: Diagnosis, Treatment and Prevention)

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