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

Nishizawa, Toshihiro; Suzuki, Hidekazu; Akimoto, Teppei; Maehata, Tadateru; Morizane, Toshio; Kanai, Takanori; Yahagi, Naohisa

doi:10.1177/2050640615588023

Cited by 16 publications

(17 citation statements)

References 20 publications

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“…[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

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

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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“…Most endoscopic physicians currently treat patients with PPIs before gastric ESD. However, recent studies have shown that preoperative PPIs may not provide additional benefits …”

Section: Precautions Against Bleeding After Gastric Esdmentioning

confidence: 99%

Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

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Endoscopic submucosal dissection (ESD) is generally used to treat gastric mucosal and submucosal lesions. Nevertheless, ESD is more difficult and complicated to perform than a traditional endoscopic mucosal resection, which can increase the incidence of various complications including hemorrhage, perforation and infection. Hemorrhage is a major post‐ESD complication. Prevention and early diagnosis of post‐ESD bleeding for gastric lesions are closely associated with the efficacy and safety of the operation. Many studies have reported the risks of and the preventative measures for hemorrhage after gastric ESD, but there remain some issues to be solved. We thus reviewed the risk factors, precautions and treatments for hemorrhage after ESD of gastric lesions.

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“…Several studies support our findings. In a meta-analysis including four Korean and Japanese randomized controlled trials, the mean gastric pH before PPI administration was relatively high (5.9±2.5) 28. In countries with high prevalence of H. pylori infection, atrophic gastritis is common especially in patients with gastric epithelial neoplasm.…”

Section: Discussionmentioning

confidence: 99%

Continuous Infusion versus Intermittent Dosing with Pantoprazole for Gastric Endoscopic Submucosal Dissection

et al. 2019

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Background/AimsProton pump inhibitors are widely used to prevent gastric endoscopic submucosal dissection (ESD)-related bleeding, but no standard administration regimens have been established. We aimed to prospectively compare the effects of continuous infusion and intermittent dosing with pantoprazole on preventing gastric ESD-related bleeding. Additionally, we analyzed the risk factors for bleeding.MethodsFrom April 2012 to May 2013, patients with a gastric epithelial neoplasm scheduled for ESD in the Pusan National University Hospital were randomly assigned to one of two groups according to the pantoprazole administration regimen (continuous infusion or intermittent dosing). The primary outcomes measured were intra- and postprocedural bleeding events.ResultsThe final analysis included 401 patients. The rate of significant intraprocedural bleeding was 25.4% in the C group and 24.0% in the I group, with no significant difference (p=0.419). In addition, there was no significant difference in the postprocedural bleeding rate between the C and I groups (11.7% vs 10.2%, p=0.374). Multivariate analysis showed that intraprocedural bleeding was associated with the proximal tumor location, the presence of fibrosis, and the size of the resected specimen, whereas postprocedural bleeding was associated with the size of the resected specimen and the procedure/coagulation time.ConclusionsIntermittent dosing with pantoprazole is sufficient and cost-effective for the prevention of gastric ESD-related bleeding. Operators should consider tumor characteristics when planning ESD to minimize the risk of intraprocedural bleeding, and patients with large iatrogenic ulcers should be carefully monitored for postprocedural bleeding.

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

Cited by 16 publications

References 20 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Bleeding after endoscopic submucosal dissection of gastric lesions

Continuous Infusion versus Intermittent Dosing with Pantoprazole for Gastric Endoscopic Submucosal Dissection

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