Prevention of delayed bleeding with vonoprazan in upper gastrointestinal endoscopic treatment

Abe, Hiroko; Hatta, Waku; Ogata, Yohei; Koike, Tomoyuki; Saito, Masahiro; Jin, Xun; Nakagawa, Kenichiro; Kanno, Takeshi; Uno, Kaname; Asano, Naoki; Imatani, Akira; Nakamura, Tomohiro; Nakaya, Naoki; Tarasawa, Kunio; Fujimori, Kenji; Fushimi, Kiyohide; Masamune, Atsushi

doi:10.1007/s00535-021-01781-4

Cited by 17 publications

(24 citation statements)

References 40 publications

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“… 105 , 106 , 108 , 109 , 118 A meta‐analysis revealed that endoscopic mucosal defect closure techniques significantly reduced delayed bleeding in duodenal endoscopic resection (risk ratio, 0.14; delayed bleeding rate, 2.0% vs. 17.3%). 118 Furthermore, a recent database analysis found that the use of vonoprazan showed a significant reduction of delayed bleeding compared to PPI in ESD for duodenal tumors, 34 although this study did not consider the effect of endoscopic preventive procedures after ESD. Thus, endoscopic mucosal defect closure techniques should now be mandatory for preventing delayed bleeding, and vonoprazan intake has the possibility to reduce this complication as compared to PPI.…”

Section: Duodenal Esdmentioning

confidence: 92%

“… 88 A recent database analysis using propensity‐score methods demonstrated that vonoprazan had a significant reducing effect of approximately 30% on delayed bleeding compared with PPI (Table 3 ). 34 Furthermore, vonoprazan ≥20 mg/day, but not <20 mg/day, showed a reduced risk of bleeding in comparison with standard/high‐dose PPI in gastroduodenal ESD. Similar results were achieved when gastroduodenal ESD was limited to ESD for gastric tumors.…”

Section: Gastric Esdmentioning

confidence: 98%

“…Delayed bleeding in esophageal ESD is considered relatively rare, and the rate of this complication was reported as 0.0%–6.7%. 3 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 No studies have reported the risk factors for delayed bleeding in esophageal ESD. Although the guidelines do not recommend proton pump inhibitor (PPI) after esophageal ESD, 22 a recent large‐scale database study revealed that vonoprazan, which is a novel oral potassium‐competitive acid blocker with strong and sustained acid‐inhibitory activity, 35 had a tendency to reduce delayed bleeding after esophageal ESD in the middle or lower part of the esophagus.…”

Section: Esophageal Esdmentioning

confidence: 99%

“…Although the guidelines do not recommend proton pump inhibitor (PPI) after esophageal ESD, 22 a recent large‐scale database study revealed that vonoprazan, which is a novel oral potassium‐competitive acid blocker with strong and sustained acid‐inhibitory activity, 35 had a tendency to reduce delayed bleeding after esophageal ESD in the middle or lower part of the esophagus. 34 This report addressed the possible reasons as the lower clearance of refluxate by esophageal motility impairment after esophageal ESD 36 and the necessity of strict acid suppression to control bleeding (pH > 6 is required in upper GI bleeding 37 ). However, further studies are demanded for confirming the advantage of vonoprazan to prevent delayed bleeding in esophageal ESD and its cost‐effectiveness should also be evaluated.…”

Section: Esophageal Esdmentioning

confidence: 99%

“…However, further studies are demanded for confirming the advantage of vonoprazan to prevent delayed bleeding in esophageal ESD and its cost‐effectiveness should also be evaluated. 34 …”

Section: Esophageal Esdmentioning

confidence: 99%

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Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

et al. 2021

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Although endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for upper gastrointestinal (GI) tumors, patients undergoing upper GI ESD sometimes fall into a serious condition from complications. Thus, it is important to fully understand how to prevent complications when performing upper GI ESD. One of the major complications in esophageal and gastric ESD is intraoperative perforation. To prevent this complication, blind dissection should be avoided. Traction‐assisted ESD is a useful technique for maintaining good endoscopic view. This method was proven to reduce the incidence of intraoperative perforation, which would become a standard technique in esophageal and gastric ESD. In gastric ESD, delayed bleeding is the most common complication. Recently, a novel prediction model (BEST‐J score) consisting of 10 factors with four risk categories for delayed bleeding in gastric ESD was established, and a free mobile application is now available. For reducing delayed bleeding in gastric ESD, vonoprazan ≥20 mg/day is the sole reliable method in the current status. Duodenal ESD is still challenging with a much higher frequency of complications, such as perforation and delayed bleeding, than ESD in other organs. However, with the development of improved devices and techniques, the frequency of complications in duodenal ESD has been decreasing. To prevent intraoperative perforation, some ESD techniques, such as using the distal tips of the Clutch Cutter, were developed. An endoscopic mucosal defect closure technique would be mandatory for preventing delayed complications. However, several unresolved issues, including standardization of duodenal ESD, remain and further studies are demanded.

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Section: Duodenal Esdmentioning

confidence: 92%

Section: Gastric Esdmentioning

confidence: 98%

Section: Esophageal Esdmentioning

confidence: 99%

Section: Esophageal Esdmentioning

confidence: 99%

“…However, further studies are demanded for confirming the advantage of vonoprazan to prevent delayed bleeding in esophageal ESD and its cost‐effectiveness should also be evaluated. 34 …”

Section: Esophageal Esdmentioning

confidence: 99%

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