Prospective single-arm trial of two-week rabeprazole treatment for ulcer healing after gastric endoscopic submucosal dissection

Keiko Niimi, Mitsuhiro Fujishiro, Osamu Goto, Shinya Kodashima, Chihiro Minatsuki, Itsuko Hirayama, Satoshi Mochizuki, Satoshi Ono, Nobutake Yamamichi, Naomi Kakushima, Masao Ichinose, Kazuhiko Koike

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27 Citations (Scopus)

Abstract

Aim: Endoscopic submucosal dissection (ESD) causes artificial ulcers, and there is no consensus regarding the degree of healing in ESD-induced ulcers or the optimal duration of proton pump inhibitor (PPI) treatment. The aim of the present study was to investigate the healing rates of post-ESD ulcers in response to the protective effect of 2-week PPI treatment. Methods: Between February 2007 and March 2010, 75 patients/75 lesions and 55 patients/55 lesions were enrolled as interim and per-protocol groups, respectively. All patients were prescribed rabeprazole (10 mg/day) orally for 16 days beginning on the day before ESD. Follow-up endoscopy was carried out 8 weeks after ESD to evaluate ulcer healing. The primary end-point was the healing rate of post-ESD ulcers at 8 weeks after ESD. Secondary end-points were the rate of post-ESD bleeding with emergency endoscopy and the rate of other severe adverse effects during the study period. Results: The transitional rate to scarring-stage ulcers was 80.0% (44/55). Location in the lesser curve and large resected size (>40 mm) were statistically significant predictors for delayed ulcer healing by univariate analysis and the latter was still significant by the multivariate analysis. Post-ESD bleeding occurred within 2 weeks in two cases (2.7%), but both cases were successfully managed with endoscopic hemostasis only. Severe adverse effects did not occur. Conclusions: Two-week administration of PPI for post-ESD gastric ulcers may be sufficient to aid healing without increasing any adverse effects in cases where there are no possible deteriorating factors on ulcer healing, although large resection and/or resection in the lesser curve may result in delayed healing even after 8 weeks of ESD.

Original languageEnglish
Pages (from-to)110-116
Number of pages7
JournalDigestive Endoscopy
Volume24
Issue number2
DOIs
Publication statusPublished - 2012 Mar 1

Keywords

  • endoscopic submucosal dissection
  • gastric intraepithelial neoplasm
  • postoperative bleeding
  • proton pump inhibitor
  • ulcer healing

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Niimi, K., Fujishiro, M., Goto, O., Kodashima, S., Minatsuki, C., Hirayama, I., Mochizuki, S., Ono, S., Yamamichi, N., Kakushima, N., Ichinose, M., & Koike, K. (2012). Prospective single-arm trial of two-week rabeprazole treatment for ulcer healing after gastric endoscopic submucosal dissection. Digestive Endoscopy, 24(2), 110-116. https://doi.org/10.1111/j.1443-1661.2011.01178.x