Early versus Late Eradication of Helicobacter pylori after Endoscopic Submucosal Dissection of Gastric Neoplasms: A Prospective, Multicenter, Randomized, Controlled Study

Abstract

Background/Aims: Helicobacter pylori is a well-known gastric carcinogen, and its eradication is an important therapeutic strategy to prevent the development of metachronous lesions following endoscopic submucosal dissection (ESD). However, the optimal timing for H. pylori eradication following ESD remains unclear. Methods: In this multicenter, prospective, randomized trial, 191 patients undergoing ESD for gastric neoplasms were randomly assigned to either an early (3 to 5 days) or late (8 to 9 weeks) eradication group after ESD. The primary outcome was the rate of successful H. pylorieradica-tion. Secondary outcomes included the tolerability and side effects of eradication therapy in both groups. Results:Atotal of 149 patients were included in the per-protocol analysis (75 in the early eradication group and 74 in the late eradication group) after excluding patients who required surgery or were lost to follow-up. The early eradication group showed a significantly higher eradication rate compared to the late eradication group (early 80.0%, late 64.9%; p=0.045). However, the tolerability and side effects of the eradication therapy did not differ between the groups. In multivariate analysis, early initiation of eradication therapy after ESD was an independent predictor of successful eradication (odds ratio, 2.30; 95% confidence interval, 1.04 to 5.05; p=0.038). Conclusions: Early attempts to eradicate H. pylorifollowing ESD significantly increased eradication success rates without increasing the incidence of side effects. Therefore, early attempts to eradicate H. pylori after ESD may be the best option for successful eradication. (ClinicalTrials.gov identifier NCT02921399) (Gut Liver, 2025;19:821-828)