Kyoto Classification-Based Predictive Factors Associated with the Development of Gastric Cancer After Helicobacter pylori Eradication: A Prospective Multicenter Observational Study

<b>Background/Objectives</b>: This study aimed to identify specific endoscopic findings associated with the development of GC following successful <i>H. pylori</i> eradication. <b>Methods</b>: This prospective multicenter observational study included patients who underwent annual surveillance endoscopy after successful <i>H. pylori</i> eradication therapy between September 2013 and June 2019. Endoscopic findings were evaluated one year after eradication therapy and analyzed using the Kyoto Classification of Gastritis to identify factors associated with GC development. <b>Results</b>: A total of 465 patients were included, including 49 patients with GC and 416 patients without GC. At the initial endoscopic assessment (median, 0.96 years post-eradication), emergence of map-like redness and invisible regular arrangement of collecting venule (RAC) as independent predictors of GC (map-like redness: hazard ratio [HR], 2.561; 95% confidence interval [CI], 1.362-4.572; <i>p</i> = 0.003; invisible RAC: HR, 3.131; 95% CI, 1.078-9.091; <i>p</i> = 0.036). Patients with map-like redness or invisible RAC showed a significantly higher incidence of GC than those without map-like redness or invisible RAC (<i>p</i> < 0.001 and <i>p</i> < 0.001, respectively). Notably, map-like redness and visible RAC appeared in 13% and 28.4% of cases within the first year after eradication, respectively. <b>Conclusions</b>: Map-like redness and invisible RAC were identified as independent predictors of GC following <i>H. pylori</i> eradication and may serve as early predictive indicators, appearing within one year of successful eradication. This finding underscores the importance of early surveillance endoscopy in identifying patients at elevated risk for GC.