Vonoprazan versus proton-pump inhibitors for gastric endoscopic submucosal dissection-induced ulcers: a systematic review and meta-analysis

Abstract

Acid secretion inhibitors are usually prescribed to promote the healing of artificial ulcers caused by endoscopic submucosal dissection (ESD) to reduce the risk of gastric perforation and delayed bleeding. Vonoprazan is a newer agent that has been shown to be more potent than a proton-pump inhibitor (PPI). However, it remains unclear whether vonoprazan is more effective than PPI in promoting healing of ulcers caused by ESD. Medline and Embase databases were searched through January 2018 for studies that compared the rate of complete healing of ulcers caused by ESD and post-ESD delayed bleeding in patients who received vonoprazan versus those who received PPI after ESD. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect model, generic inverse variance method. The between-study heterogeneity was quantified using the Q-statistic and I. A total of six studies consisting of 461 patients were identified. The likelihood that ulcers caused by ESD were completely healed at 4-8 weeks after the procedure was significantly higher among patients who received vonoprazan compared with those who received PPI, with a pooled OR of 2.27 (95% CI=1.38-3.73; I=0%). The risk of developing post-ESD delayed bleeding was also numerically lower among those who received vonoprazan, with a pooled OR of 0.79, although the result did not reach statistical significance (95% CI=0.18-3.49; I=29%). This study found that patients who received vonoprazan after ESD had a significantly higher rate of completely healed ulcers compared with those who received PPI.

The efficacy of vonoprazan for management of post‐endoscopic submucosal dissection ulcers compared with proton pump inhibitors: A meta‐analysis

“…However, there were still some differences between these meta‐analyses. One meta‐analysis included only 6 studies with a total of 461 patients, which is much less than those in the other meta‐analysis; and in the meta‐analysis by Kang et al, the healing rate at 8 weeks post‐ESD was significantly higher in the PPI group than in the vonoprazan group, which was contrary to that reported by Jaruvongvanich et al's study . These results are different from our study because two studies were not included in their studies.…”

“…Recently, there have been two meta‐analyses focusing on the efficacy and safety of vonoprazan compared with PPIs for treating post‐ESD ulcers, both showing that vonoprazan treated artificial ulcers more rapidly and effectively than PPIs. However, there were still some differences between these meta‐analyses.…”

Vonoprazan vs proton pump inhibitors in treating post-endoscopic submucosal dissection ulcers and preventing bleeding

“…[ 29 ] However, Otsuka et al reported that most ESD-induced ulcers were actually healed by 4 weeks, which implies that early-phase (by 2 weeks) evaluation is important for effective drug treatment. The previous meta-analyses [ 30 – 32 ] did not assess 2-week evaluation points and featured biased study selection and data extraction. Furthermore, several additional clinical trials [ 18 , 20 , 25 ] were published after these meta-analyses.…”

Efficacy of vonoprazan for the prevention of bleeding after gastric endoscopic submucosal dissection with continuous use of antiplatelet agents

“…Although several reports have supported the conclusion that vonoprazan promotes more effective postoperative healing [33][34][35], some found no difference in its ulcer-healing ability, 4 or 8 weeks following gastric ESD [36,37]. A systematic review and meta-analysis of these reports showed that patients treated with vonoprazan demonstrated a significantly higher rate of completely healed ulcers, compared to that observed in those managed with PPIs [38]. Although controversy remains regarding the ▶ Table 3 Incidence rate of post-endoscopic submucosal dissection (ESD) bleeding.…”