Effect of sucralfate granules in suspension on endoscopic variceal sclerotherapy induced ulcer: Analysis of the factors determining ulcer healing

Abstract

Oesophageal ulcers commonly occur after endoscopic variceal sclerotherapy and usually cause complications and a delay in further sclerotherapy. The aims of this study are to investigate the effect of sucralfate granules in suspension on the treatment of endoscopic variceal sclerotherapy induced ulcer and analyse the factors determining the ulcer healing. Fifty-two patients with oesophageal variceal bleeding received elective endoscopic variceal sclerotherapy. After endoscopically proved oesophageal ulcers, they were randomized to receive either sucralfate granules in suspension (n = 22) or antacid (n = 23). Follow-up endoscopy was performed weekly. Ulcer healing rates were compared between the groups using the log-rank test. Forty-one ulcers receiving sucralfate and 48 ulcers receiving antacid treatment were evaluated. The clinical characteristics of the ulcers were similar in both groups. The ulcers in patients receiving sucralfate healed faster than those receiving antacid (P<0.02). On analysis of factors affecting ulcer healing, ulcers smaller than 1 cm2 (n = 59) appeared to heal faster than those larger than 1 cm2 (n = 30; P= 0.059) and shallow ulcers (n = 46) healed faster than deep ulcers (n = 43; P<0.001). On multifactorial analysis, ulcer depth was the only factor determining ulcer healing. The ulcer healing effects of sucralfate became more prominent when the ulcer was larger than 1.0cm2 (1.7+/-0.6 weeks vs 2.3+/-0.6 weeks, P= 0.011) and deep (1.7+/-0.7 weeks vs 2.5+/-1.0 weeks, P= 0.013) when compared with those receiving antacid. Sucralfate granules in suspension speed the healing of endoscopic variceal sclerotherapy induced ulcer, especially deep and large ulcers.

Predictive factors of bleeding related to post‐banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case‐control study

“…The use of sucralfate, known for its experimental mucosal cyto‐protective action, has been proposed to improve the ulcer healing following variceal sclerotherapy and ligation 22–24 . Compared with antacid, sucralfate allowed a faster post‐EVL ulcer healing in a group of 45 randomized cirrhotic patients, but the association of both drugs was not assessed 25 . In our study, we failed to find any benefit in the use of sucralfate for the prevention of bleeding related to post banding ulcer, but the number of treaded patients treated was very low.…”

Pantoprazole reduces the size of postbanding ulcers after variceal band ligation

“…Conversely, treatment of sclerotherapy ulcers with sucralfate was shown to speed healing in a randomized controlled trial of 45 patients. 26 There are some data to suggest that sclerotherapy ulcers might benefit from treatment with H2 receptor antagonists. 27 However, in a randomized controlled trial of proton pump inhibitors, Garg and colleagues 28 were unable to demonstrate a beneficial effect of omeprazole on postsclerotherapy ulcers.…”

Implantation of self-expanding metal stent in the treatment of severe bleeding from esophageal ulcer after endoscopic band ligation

“…Endoscopic hemostasis was obtained by EBL with eight bands using an MBL‐10‐F ligation device (Wilson Cook ® Medical, Winston‐Salem, NC, USA). The standardized treatment protocol in the post‐EBL period included omeprazole and sucralfate in the doses of 40 mg/24 h and 4 g/24 h, respectively 6,13–17 …”