Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: A prospective randomized controlled trial

Noriya Uedo, Yoji Takeuchi, Takuya Yamada, Ryu Ishihara, Hideharu Ogiyama, Sachiko Yamamoto, Motohiko Kato, Koichi Tatsumi, Eriko Masuda, Chie Tamai, Shunsuke Yamamoto, Koji Higashino, Hiroyasu Iishi, Masaharu Tatsuta

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

OBJECTIVES: With conventional methods of endoscopic mucosal resection for early gastric cancer (EGC), proton pump inhibitors (PPIs) and H 2-receptor antagonists (H2RAs) have a similar effect on preventing bleeding from artificial ulcers. An objective of this study is to investigate whether a stronger acid suppressant (i.e., PPI) more effectively prevents bleeding after the recent advanced technique of endoscopic submucosal dissection (ESD) for EGC. METHODS: This was a prospective randomized controlled trial performed in a referral cancer center. A total of 143 patients with EGC who underwent ESD were randomly assigned to the treatment groups. They received either rabeprazole 20 mg (PPI group) or cimetidine 800 mg (H2RA group) on the day before ESD and continued for 8 wk. The primary end point was the incidence of bleeding that was defined as hematemesis or melena that required endoscopic hemostasis and decreased the hemoglobin count by more than 2 g/dL. RESULTS: In baseline data, the endoscopists who performed the ESD were significantly different between the groups. Finally, 66 of 73 patients in the PPI group and 64 of 70 in the H2RA group were analyzed. Bleeding occurred in four patients in the PPI group and 11 in the H2RA group (P = 0.057). Multivariate analysis revealed that treatment with the PPI significantly reduced the risk of bleeding: adjusted hazard ratio 0.47, 95% confidence interval 0.22-0.92, P = 0.028. One delayed perforation was experienced in the H2RA group. CONCLUSIONS: PPI therapy more effectively prevented delayed bleeding from the ulcer created after ESD than did H2RA treatment.

Original languageEnglish
Pages (from-to)1610-1616
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume102
Issue number8
DOIs
Publication statusPublished - 2007 Aug 1
Externally publishedYes

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Histamine H2 Receptors
Proton Pump Inhibitors
Ulcer
Stomach Neoplasms
Randomized Controlled Trials
Hemorrhage
Rabeprazole
Endoscopic Hemostasis
Melena
Hematemesis
Cimetidine
Therapeutics
Endoscopic Mucosal Resection
Hemoglobins
Referral and Consultation
Multivariate Analysis
Confidence Intervals
Acids
Incidence

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer : A prospective randomized controlled trial. / Uedo, Noriya; Takeuchi, Yoji; Yamada, Takuya; Ishihara, Ryu; Ogiyama, Hideharu; Yamamoto, Sachiko; Kato, Motohiko; Tatsumi, Koichi; Masuda, Eriko; Tamai, Chie; Yamamoto, Shunsuke; Higashino, Koji; Iishi, Hiroyasu; Tatsuta, Masaharu.

In: American Journal of Gastroenterology, Vol. 102, No. 8, 01.08.2007, p. 1610-1616.

Research output: Contribution to journalArticle

Uedo, Noriya ; Takeuchi, Yoji ; Yamada, Takuya ; Ishihara, Ryu ; Ogiyama, Hideharu ; Yamamoto, Sachiko ; Kato, Motohiko ; Tatsumi, Koichi ; Masuda, Eriko ; Tamai, Chie ; Yamamoto, Shunsuke ; Higashino, Koji ; Iishi, Hiroyasu ; Tatsuta, Masaharu. / Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer : A prospective randomized controlled trial. In: American Journal of Gastroenterology. 2007 ; Vol. 102, No. 8. pp. 1610-1616.
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T1 - Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer

T2 - A prospective randomized controlled trial

AU - Uedo, Noriya

AU - Takeuchi, Yoji

AU - Yamada, Takuya

AU - Ishihara, Ryu

AU - Ogiyama, Hideharu

AU - Yamamoto, Sachiko

AU - Kato, Motohiko

AU - Tatsumi, Koichi

AU - Masuda, Eriko

AU - Tamai, Chie

AU - Yamamoto, Shunsuke

AU - Higashino, Koji

AU - Iishi, Hiroyasu

AU - Tatsuta, Masaharu

PY - 2007/8/1

Y1 - 2007/8/1

N2 - OBJECTIVES: With conventional methods of endoscopic mucosal resection for early gastric cancer (EGC), proton pump inhibitors (PPIs) and H 2-receptor antagonists (H2RAs) have a similar effect on preventing bleeding from artificial ulcers. An objective of this study is to investigate whether a stronger acid suppressant (i.e., PPI) more effectively prevents bleeding after the recent advanced technique of endoscopic submucosal dissection (ESD) for EGC. METHODS: This was a prospective randomized controlled trial performed in a referral cancer center. A total of 143 patients with EGC who underwent ESD were randomly assigned to the treatment groups. They received either rabeprazole 20 mg (PPI group) or cimetidine 800 mg (H2RA group) on the day before ESD and continued for 8 wk. The primary end point was the incidence of bleeding that was defined as hematemesis or melena that required endoscopic hemostasis and decreased the hemoglobin count by more than 2 g/dL. RESULTS: In baseline data, the endoscopists who performed the ESD were significantly different between the groups. Finally, 66 of 73 patients in the PPI group and 64 of 70 in the H2RA group were analyzed. Bleeding occurred in four patients in the PPI group and 11 in the H2RA group (P = 0.057). Multivariate analysis revealed that treatment with the PPI significantly reduced the risk of bleeding: adjusted hazard ratio 0.47, 95% confidence interval 0.22-0.92, P = 0.028. One delayed perforation was experienced in the H2RA group. CONCLUSIONS: PPI therapy more effectively prevented delayed bleeding from the ulcer created after ESD than did H2RA treatment.

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