Contributing Factors to Gastric Ulcer Healing After Endoscopic Submucosal Dissection Including the Promoting Effect of Rebamipide

Kobayashi, Mariko; Takeuchi, Manabu; Hashimoto, Satoru; Mizuno, Ken‐ichi; Sato, Yuichi; Narisawa, Rintaro; Aoyagi, Yoshinobu

doi:10.1007/s10620-011-1850-4

Cited by 45 publications

(53 citation statements)

References 23 publications

(32 reference statements)

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“…We found that large artificial ulcers and location of the lesion in the lower third of the gastric tract to be independent risk factors of delayed post-ESD ulcer healing. Our finding of delayed healing of large artificial ulcers is consistent with the results of Kobayashi et al [9] and Oh et al [10]. Size of artificial ulcer after ESD has also been reported to affect the healing rate of artificial ulcers in previous studies [9,10,14], supporting our findings.…”

Section: Discussionsupporting

confidence: 93%

“…However, there is no current consensus regarding the optimal duration of PPI or P-CAB treatment after ESD based on the various factors that can influence healing of post-ESD ulcers. Potential predictive factors of delayed ulcer healing include the large size of artificial ulcers [9,10], the use of H2RA after ESD [5,6], preoperative fibrosis in the submucosal layer of the lesions [3], damage to the muscularis propria layer during the ESD procedure [11], location of the resected lesion in the lesser curvature [12], and lesions combined with severe atrophic gastritis [13]. However, these risk factors were identified prior to the release of P-CABs and, therefore, these studies did not consider P-CAB treatment.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Delayed Ulcer Healing after Endoscopic Submucosal Dissection of Gastric Neoplasms

Shimozato

Sasaki

Ogasawara

et al. 2017

JGLD

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Background & Aims: With improved technology, the size of artificial ulcers after endoscopic submucosal dissection (ESD) has increased. The aim of our study was to examine the risk factors for delayed gastric ulcer healing after ESD, including the possible benefit of potassium-competitive acid blocker (P-CAB) treatment.Methods: The primary outcome was the rate of healing of the artificial ulcers induced by ESD at 8 weeks post intervention. Design: retrospective case series. Setting: Aichi Medical University Hospital. Patients: patients who underwent ESD for gastric neoplasm, between April 2015 and March 2017. Intervention: ESD, with a follow-up endoscopic examination at 8 weeks post-ESD. Univariate and multivariate analyses were used to identify the independent risk factors for delayed healing.Results: Of the 73 gastric neoplasms included in the analysis, delayed ulcer healing was identified in 21.9%. Dyslipidemia (p=0.04), ESD procedure time (p=0.003) and artificial ulcer size (p<0.001) were identified as risk factors for delayed healing, with location in the lower third of the stomach [Odds ratio (OR) 6.76; p=0.016] and artificial ulcer size (OR, 1.18; p=0.024) retained as independent risk factors. A cut-off ulcer size of 854 mm2 was predictive of delayed healing, with a sensitivity of 29.8% and specificity of 87.5%. For large ulcers, the rate of healing of 70% with vonoprazan was higher than the rate of 47.6% with proton pump inhibitors (PPIs), although this difference was not significant.Conclusion: For artificial ulcers after ESD with a resection diameter >35 mm, it might be desirable to use PPIs for >8 weeks or P-CAB.Abbreviations: EGC: early gastric cancers; EMR: endoscopic mucosal resection; ESD: endoscopic submucosal dissection; H. pylori: Helicobacter pylori; H2RA: H2-receptor antagonist: PRP: platelet rich plasma; PGA: polyglycolic acid; P-CAB: potassium-competitive acid blocker; PPI: proton pump inhibitor.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Delayed Ulcer Healing after Endoscopic Submucosal Dissection of Gastric Neoplasms

Shimozato

Sasaki

Ogasawara

et al. 2017

JGLD

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“…A synergic effect with another approach, such as a shielding method [16], is necessary. Several studies have targeted post-ESD ulcer healing as a primary end point by using antisecretory agents and/or mucoprotective agents [23][24][25][26][27]. These studies clearly elucidated the difference between peptic ulcer and artificial post-ESD ulcer.…”

Section: Discussionmentioning

confidence: 99%

“…Takayama et al [23] revealed that 1 week of PPI treatment followed by 7 weeks of rebamipide treatment had effects similar to those of 8 weeks of PPI treatment with regard to post-ESD ulcer healing. Kobayashi et al [24] compared 8 weeks of treatment with a PPI alone and 8 weeks of treatment with a PPI plus rebamipide. Although ulcer healing was evaluated 4-6 weeks after ESD, the healing ratio with regard to scar stage was similar in both groups, but the quality of basal healing was significantly better in the combination group among patients with large resection in the subanalysis.…”

Section: Complications and Their Preventionmentioning

confidence: 99%

Updated evidence on endoscopic resection of early gastric cancer from Japan

et al. 2016

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“…In randomized controlled studies, rebamipide has been found to prevent nonsteroidal anti-inflammatory drug (NSAID)-induced peptic ulcers, accelerate gastric ulcer healing and suppress mucosal inflammation in patients with chronic erosive gastritis (6,7). Recently, several studies (8)(9)(10)(11)(12)(13)(14) have examined the efficacy of rebamipide and PPI combination therapy for the treatment of ESD-induced ulcers. However, there is currently no consensus regarding the optimal treatment duration or drug regimen.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Proton Pump Inhibitors (PPIs) Plus Rebamipide for Endoscopic Submucosal Dissection-induced Ulcers: A Meta-analysis

Wang

Guo

et al. 2014

Intern. Med.

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Objective To compare the efficacy of proton pump inhibitors (PPIs) with rebamipide versus PPIs alone for the treatment of ulcers after endoscopic submucosal dissection (ESD). Methods PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and China Naitonal Knowledge Infrastructure were searched up to the end of October 2013 in order to identify all randomized controlled trials reporting the effects of PPIs plus rebamipide on healing ulcers after ESD. The outcome measurement was complete ulcer healing. Results A total of six studies involving 724 patients were included. The pooled data suggested a significantly higher rate of ulcer healing after endoscopic therapy among patients treated with PPIs plus rebamipide than among those treated with PPIs alone [odds ratio (OR)=2.40, 95% confidence interval (CI): 1.68-3.44]. The subgroup analysis showed PPI plus rebamipide therapy to be more effective in healing ESD-induced ulcers than treatment with PPIs alone after both four (OR=2.22, 95%CI: 1.53-3.24) and eight weeks of treatment (OR=3.19, 95%CI: 1.22-8.31). In addition, the combination therapy was found to be significantly more effective than the use of PPIs alone for all ESD ulcers greater than 20 mm in size (OR=4.77, 95%CI: 2.22-10.26). There were no significant differences between the treatment groups with regard to ulcer location (low, middle or upper stomach) or the presence of absence of H. pylori infection. No serious adverse events were observed in either group. Conclusion The results of this meta-analysis suggest that treatment with PPIs plus rebamipide is superior to PPI monotherapy for healing ESD-induced ulcers over four weeks, particularly large ulcers. However, more well-designed trials are needed to confirm these findings.

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Contributing Factors to Gastric Ulcer Healing After Endoscopic Submucosal Dissection Including the Promoting Effect of Rebamipide

Abstract: Healing in ESD-induced ulcers was dependent on the initial ulcer size. In large-sized ulcers, rebamipide promotes basal healing.

Cited by 45 publications

References 23 publications

Risk Factors for Delayed Ulcer Healing after Endoscopic Submucosal Dissection of Gastric Neoplasms

Risk Factors for Delayed Ulcer Healing after Endoscopic Submucosal Dissection of Gastric Neoplasms

Updated evidence on endoscopic resection of early gastric cancer from Japan

Efficacy and Safety of Proton Pump Inhibitors (PPIs) Plus Rebamipide for Endoscopic Submucosal Dissection-induced Ulcers: A Meta-analysis

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