Background:
Endoscopic submucosal dissection (ESD) is a standard procedure for treating gastric neoplasms. However, ESD causes larger artificial ulcers other than mucosal resection methods. We conducted this prospective randomized controlled study to evaluate the effect of stronger acid suppression on ESD ulcers caused by doubling the proton pump inhibitor (PPI) dose and compare the effects of 20-mg (standard dose) and 40-mg (double dose) esomeprazole (EswonampTM, Daewon Pharmaceutical Co., Ltd., Seoul, Korea) on ulcer healing.
Methods:
One hundred ninety-seven patients who underwent gastric ESD from July 2017 to December 2017 at Pusan National University Yangsan Hospital were enrolled and randomly assigned to the standard or double-dose group. Change in ulcer size from the day of ESD to 4 weeks after ESD and the scar-change rate were compared between the groups.
Results:
There were no significant differences in ulcer contraction (84.5% in 20 mg group vs 86.3% in 40 mg group,
P
= .91) or scar-change rate (30.9% vs 30.6%,
P
> .99) between the groups. In a multivariate analysis, initial ulcer size [odds ratio (OR) 0.24; 95% confidence interval (CI) 0.11–0.50] and early gastric cancer (OR 0.22, 95% CI 0.08–0.58) were significantly associated with delayed ulcer healing.
Conclusions:
Both 40 and 20-mg esomeprazole have similar effects on ESD-induced ulcer area reduction, suggesting that strong acid suppression does not necessarily result in rapid artificial ulcer healing.
Trial registration number:
RCT no.: KCT0002885
Background: The efficacy of cap-assisted, water-aided, and 12 o'clock-prone position colonoscopy as individual techniques for adenoma detection is well documented. However, the efficacy of the combination of the three colonoscopy methods is unclear. Therefore, the present study aimed to retrospectively compare the efficacy between combined-method colonoscopy (CMC) and standard colonoscopy (SC).
Methods and Findings: A total of 746 patients who underwent either CMC or SC, performed by two board-certified gastroenterologists between December 2019 and March 2020 at Baekyang Jeil Internal Medicine Clinic, were retrospectively evaluated. We evaluated polyp detection rate (PDR), adenoma detection rate (ADR), and mean number of adenomas detected per procedure (MAP). Statistical analysis for comparison between the groups was performed using the Student's t-test, and ADR and PDR were analyzed using Fisher's exact test. The study population was predominantly women (55.4%). The mean patient age (standard deviation) was 62.87 (±7.83) years. There was no significant difference in sex, number of fecal occult blood test-positive patients, and age between the two groups. The PDR, ADR, and proximal colon MAP were significantly higher in the CMC group than in the SC group (PDR: 59.8% vs. 84.9%, p < 0.001; ADR: 49.2% vs. 70.1%, p < 0.001; proximal colon MAP: 0.55 vs. 1.24, p < 0.001).
Conclusions: Compared with SC, CMC increases PDR, ADR, and MAP, especially proximal colon MAP. Therefore, CMC may be more useful than SC in clinical settings. This study is the first to evaluate the efficacy of the three techniques in combination.
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