Oral Rabeprazole Administration on a Procedure Day Suppresses Bleeding After Endoscopic Submucosal Dissection for Gastric Neoplasms

Abstract

: [Aim] The efficacy of pre -procedure oral proton pump inhibitor (PPI) administration for gastric endoscopic submucosal dissection (ESD) is unclear. This study evaluated oral PPI administration effectiveness on the day of ESD to prevent post -ESD bleeding. [Methods] This study examined 55 patients who underwent ESD for gastric neoplasm. Group A comprised 31 patients who took rabeprazole sodium (RPZ) 20 mg/day beginning 7 -8 hr before ESD. Group B comprised 24 who took RPZ 20 mg/day beginning three days before ESD. Gastric pH (G -pH) was measured at one month before ESD (pre -ESD pH), immediately before ESD (ESD pH), and seven days after ESD (post -ESD pH). The post -ESD bleeding rate and changes in G -pH were recorded. [Results] No significant difference in post -ESD bleeding rates was found (Group A 3.2%, Group B 0%). ESD pH and post -ESD pH were significantly higher than pre -ESD pH in both groups (P<0.001). The ESD pH for Group A was higher than 6 (6.5±1.1), providing hemostasis for intragastric bleeding.[Conclusions] Oral RPZ administration on the day of gastric ESD can suppress post -ESD bleeding equivalently to administration three days before ESD.

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

“…Medications (PPIs, H 2 RAs, and mucoprotectives). Pretreatment with PPIs before ESD was not associated with PPB reduction 11,[77][78][79] as well as ecabet sodium added to PPIs. 62 Bolus PPI injection for 3 days yielded similar PPB rates when compared with 72 hours' perfusion in an RCT.…”

Effects of preoperative proton pump inhibitor administration on bleeding after gastric endoscopic submucosal dissection: A systematic review and meta‐analysis

“…However, there was significant heterogeneity among the trial results (I 2 ¼ 91.3%, p < 0.0001). Watanabe et al 9 and Ono et al 10 administered PPI after ESD on the day of the ESD (post-ESD group), while Baeg et al 11 and Hikichi et al 12 administered PPI before ESD on the day of the ESD (pre-ESD group). Subgroup analysis indicated a significantly higher gastric pH with preoperative PPI use compared with no premedication for both the pre-and post-ESD groups, and the heterogeneity disappeared (p ¼ 0.43 and p ¼ 0.17, respectively).…”

“…9 However, other studies showed that premedication did not influence post-ESD bleeding rates. [10][11][12] We proposed that systematically pooling data from all published reports might provide a better understanding of the efficacy of preoperative PPI use for preventing post-ESD bleeding. Our objective was to perform a systematic review and meta-analysis of RCTs comparing the impact of no premedication versus preoperative PPI use on post-ESD bleeding.…”

Updated evidence on endoscopic resection of early gastric cancer from Japan

“…Proton pump inhibitor (PPI) administration starting 3 days before ESD could not reduce post-ESD ulcer bleeding compared with PPI administration starting on the day of the procedure [19]. Because conflicting results were reported in terms of the effects of PPIs and histamine H 2 receptor antagonists (H2RAs) for prevention of post-ESD ulcer bleeding and for post-ESD ulcer healing, Imaeda et al [20] and Tomita et al [21] compared them, but could not reveal the superiority of PPIs over H 2 receptor antagonists H2RAs with regard to both post-ESD ulcer bleeding and post-ESD ulcer healing.…”

“…Three RCTs regarding antisecretory agents for prevention of post-ESD ulcer bleeding were identified [19][20][21]. Proton pump inhibitor (PPI) administration starting 3 days before ESD could not reduce post-ESD ulcer bleeding compared with PPI administration starting on the day of the procedure [19].…”