Proton Pump Inhibitor Dose-Related Healing Rate of Artificial Ulcers after Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

Abstract

Background/Aims: Two studies have reported on the superiority of a proton pump inhibitor (PPI) compared with a histamine-2-receptor antagonist for the treatment of artificial ulcers after endoscopic submucosal dissection (ESD), but the optimal dose of PPI remains to be defined. The aim of this study was to evaluate the possibility of reducing the dose of PPI. The authors thus compared 30 mg (standard-dose) and 15 mg (half-dose) lansoprazole in terms of ulcer healing, prevention of bleeding and quality of life. Methods: 91 patients with gastric mucosal neoplasm were enrolled. All patients who underwent ESD were administered lansoprazole 30 mg daily during the first week, after which they were randomly assigned to either the standard-dose or half-dose group. Results: One patient in each group developed hematemesis. The stage of ulcers, ulcer reduction ratios and scores on the Gastrointestinal Symptom Rating Scale did not differ at 28 and 56 days. The costs of PPI for the half-dose group and standard-dose group were 7,326.5 and 11,698.4 JPY, respectively, i.e. a difference of 471.9 JPY. Conclusions: A reduced dose of PPI after 1 week of ESD was equivalent in treatment performance to the standard dose and cheaper.

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

“…There may have been a difference in the ulcer scarring rate because of possible differences in the baseline data such as ulcer size, history of gastric operation, and use of anti-platelet or inflammatory drugs. However, several authors have reported that iatrogenic ulcers reached the scar stage at 4 weeks after EMR/ESD in 17% of the PPI group [11], 15% of the PPI group [12], approximately 10% of the PPI group [4,13], and 0% of the PPI plus sucralfate group [1], which were similar to our scarring rate results in the PPI group at 4-6 weeks.…”

Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer

“…With this regimen, there were no complaints of dysphagia after ESD. [20][21][22][23] In this study, at a median follow-up of 12 months (range 3-27 months), all cases of curative resection revealed neither local recurrence nor distant metastasis, including one case defined as a GI stromal tumor. The histopathology of tumors of the esophageal muscularis propria in our series generally reveals that they are benign leiomyomas or small stromal tumors.…”

“…Postoperative bleeding may be reduced with the routine use of stronger acid suppressant proton pump inhibitors. 20 Stricture formation occurs secondary to extensive EMR/ ESD. Ono et al 21 analyzed postoperative strictures of esophageal mucosa disease treated with ESD.…”

Esophageal Leiomyoma Originating in the Muscularis Propria Layer Resected by Endoscopic Submucosal Dissection

“…15 In conclusion, as a minimally invasive technique, ESD is a feasible and safe option to treat relatively small-sized esophageal SETs originating in the muscularis propria layer without significant complications. Moreover, precise histopathologic information was also obtained.…”