The effect of PPIs Alone,PPIs plus cytoprotective agent,and H2RA plus cytoprotective agent on ulcer healing after endoscopic submucosal dissection: A prospective randomized controlled trial |
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| Authors: | Jong Yoon Lee Jin Seok Jang |
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| Institution: | 1. Department of Tropical Medicine, Ain Shams University, Cairo, Egypt;2. Department of Clinical and Chemical Pathology, Kasr Al-Ainy School of Medicine, Cairo University, Manial Street, Cairo 11562, Egypt;1. Chemical Pathology Department, Medical Research Institute, Alexandria University, Egypt;2. Department of Microbiology, Medical Research Institute, Alexandria University, Egypt;3. Department of Internal Medicine, Medical Research Institute, Alexandria University, Egypt;1. Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia;2. Department of Pathology, Faculty of Medicine, Minia University, Al-Minia, Egypt;3. Department of Pathology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia;1. Microbiology and Immunology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt;2. Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt;3. Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt;1. Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong 518100, China;2. Department of Liver Disease Center, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong 518100, China;3. Information Management Section, Bethune International Peace Hospital, Shijiazhuang City, Hebei Province 050000, China;1. Clinical Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt;2. Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt |
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| Abstract: | Background and Study AimsEndoscopic submucosal dissection (ESD) is the most effective treatment for early gastric cancer or gastric adenoma. However, ESD results in iatrogenic ulcers and postoperative bleeding from ulcers. This study aimed to evaluate the effect of using a proton pump inhibitor (PPI) alone, a PPI + rebamipide combination therapy, and an H2 receptor antagonist (H2RA) + rebamipide combination therapy on ulcer healing after ESD.Patients and MethodsA total of 204 patients who underwent ESD from April 2014 to July 2017 at Dong-A University Hospital were randomly assigned to the following groups: PPI-alone group, PPI + rebamipide combination therapy group, and H2RA + rebamipide combination therapy group. However, only 156 patients were studied since we excluded those who were lost to follow-up or had diseases other than early gastric cancer or gastric adenoma. Twenty-eight days after ESD, we evaluated the ulcer residual ratio, S stage rates, ulcer bleeding ratio, and gastric pH.ResultsThis study included 156 patients (PPI-alone group: 52 patients; PPI + rebamipide group: 52 patients; H2RA + rebamipide group: 52 patients). The ulcer residual ratios were 24.3 ± 14.2%, 17.0 ± 12.1%, and 21.0 ± 13.8% in the PPI alone, PPI + rebamipide, and H2RA + rebamipide groups, respectively (P = 0.048).ConclusionsPPI + rebamipide was more effective in reducing the ulcer residual ratio after ESD. There was no statistical difference in ulcer stage and delayed bleeding after ESD among the groups. These findings showed that PPI + rebamipide had limited benefits after ESD. |
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| Keywords: | Endoscopic submucosal dissection Proton pump inhibitors Anti-ulcer agents Gastrointestinal hemorrhage Ulcer |
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