Surrounding break up after Helicobacter pylori eradication to prevent metachronous gastric cancer after endoscopic submucosal resection

Still debates exist whether Helicobacter pylori (H. pylori) eradication can impose the chance of gastric cancer prevention since the effects of H. pylori eradication on the development of metachronous gastric cancer (MGC) after endoscopic treatment. Supported with other evidences that eradication can prevent gastric cancer as well as rejuvenation of atrophic gastritis and some improvements of dyspeptic symptoms, in February 21, 2013, Japanese government decided to eradicate H. pylori in patients with chronic gastritis. This is largely due to sincere hope either to lessen gastric cancer incidence as well as mortality or improve the quality of life of Japanese people. Though H. pylori had been defined as class 1 carcinogen by IARC at 1994, several evidences confirmed that H. pylori played promoting actions gastric carcinogenesis rather than as initiator. With the findings that field cancerization is one of core pathways of H. pylori-associated gastric carcinogenesis, the answer to debates that eradication alone was insufficient to prevent MGC includes either the discovery of biomarkers to eradicate earlier before stepping into irreversible stage of gastric carcinogenesis or adoption of strategy to perform siTRP (short-term intervention to revert premalignant lesion). Therefore, surrounding break up should be considered as siTRP after the successful eradication to prevent H. pylori-associated gastric cancers.