Comparison of the efficacy of 4- and 8-week lansoprazole treatment for ESD-induced gastric ulcers: a randomized, prospective, controlled study

Park, Ji Hoon; Baek, Eun Kyung; Choi, Chang Hwan; Lee, Kyung Hun; Kim, Beom Jin; Kim, Jeong Wook; Kim, Jae Gyu; Chang, Sae Kyung

doi:10.1007/s00464-013-3177-z

“…129 Various reports regarding the dose and administration period of proton pump inhibitors for iatrogenic ulcers and concomitant use of mucosal protective agents are available. [130][131][132][133][134][135][136][137][138][139][140][141][142] Randomized trials reported that administration of proton pump inhibitors before endoscopic resection is not effective in preventing delayed bleeding and that second look endoscopy also did not effectively prevent delayed bleeding. [143][144][145] Statement G8: We recommend endoscopic closure as the first treatment option for perforation that occurred during endoscopic resection of early gastric cancer (Grade of recommendation: strong, Level of evidence: low).…”

Section: Statement G7: We Recommend Proton Pump Inhibitors To Decreasmentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Park

¹

,

Yang

²

,

Kim

³

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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“…Moreover, a 4-week course of lansoprazole is reportedly as effective as an 8-week course. 14 Among the many available PPIs, rabeprazole is commonly used in Asian countries because it is less affected by the CYP2C19 genetic polymorphism, which is more prevalent in Japan, China, and Korea than in western countries. [15][16][17] The optimal dose of rabeprazole for the resolution of post-ESD ulcers and symptom resolution is reportedly 10 mg once daily, with no apparent advantage to using higher doses.…”

Section: Introductionmentioning

confidence: 99%

A prospective randomized trial of a potassium competitive acid blocker vs proton pump inhibitors on the effect of ulcer healing after endoscopic submucosal dissection of gastric neoplasia

Kohno

¹

,

Ueyama

²

,

Nagahara

³

et al. 2019

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Background/Aims Vonoprazan is a new a potassium-competitive acid blocker (P-CAB) that was recently developed in Japan. However, vonoprazan’s efficacy in healing gastric ulcers after endoscopic submucosal dissection (ESD) remains controversial. This study aimed to compare the efficacy of P-CABs and proton pump inhibitors (PPIs) in healing post-ESD ulcers. Materials and Methods This prospective randomized controlled trial (UMIN000017386) enrolled 40 patients with gastric neoplasia, who underwent ESD at our hospital from April 2015 to January 2016. Before ESD, patients were randomly divided into the following two groups: group V, vonoprazan 20 mg/day; or group R, rabeprazole 10 mg/day. Medications were taken 1 day before to 4 weeks after ESD. The ESD-induced artificial ulcer size was measured just after ESD and 4 weeks after ESD to calculate the reduction rate as follows: (ulcer area 4 weeks after ESD)/(ulcer area just after ESD) × 100. Results Eighteen patients in group V and 15 patients in group R were analyzed. The mean reduction rate was significantly different in groups V and R (93.3% vs 96.6%, respectively). Post-ESD bleeding was observed in two patients in group R and drug-induced hepatic injury in one patient in group R. Conclusion Rabeprazole facilitated the healing process post-ESD.

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“…129 Various reports regarding the dose and administration period of proton pump inhibitors for iatrogenic ulcers and concomitant use of mucosal protective agents are available. [130][131][132][133][134][135][136][137][138][139][140][141][142] Randomized trials reported that administration of proton pump inhibitors before endoscopic resection is not effective in preventing de-layed bleeding and that second look endoscopy also did not effectively prevent delayed bleeding. [143][144][145]…”

Section: Statement G7mentioning

confidence: 99%

Clinical practice guideline for endoscopic resection of early gastrointestinal cancer

Park

¹

,

Yang

²

,

Kim

³

et al. 2021

View full text Add to dashboard Cite

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

show abstract

Comparison of the efficacy of 4- and 8-week lansoprazole treatment for ESD-induced gastric ulcers: a randomized, prospective, controlled study

Abstract: For ESD-induced gastric ulcers, treatment with lansoprazole for 4 weeks was as effective as treatment for 8 weeks. Considering cost-effectiveness, proton pump inhibitor therapy for 4 weeks may be sufficient for ESD-induced gastric ulcers.

Cited by 12 publications

References 23 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

A prospective randomized trial of a potassium competitive acid blocker vs proton pump inhibitors on the effect of ulcer healing after endoscopic submucosal dissection of gastric neoplasia

Clinical practice guideline for endoscopic resection of early gastrointestinal cancer

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