Risk Factors for Delayed Ulcer Healing after Endoscopic Submucosal Dissection of Gastric Neoplasms

Abstract

Background & Aims: With improved technology, the size of artificial ulcers after endoscopic submucosal dissection (ESD) has increased. The aim of our study was to examine the risk factors for delayed gastric ulcer healing after ESD, including the possible benefit of potassium-competitive acid blocker (P-CAB) treatment.Methods: The primary outcome was the rate of healing of the artificial ulcers induced by ESD at 8 weeks post intervention. Design: retrospective case series. Setting: Aichi Medical University Hospital. Patients: patients who underwent ESD for gastric neoplasm, between April 2015 and March 2017. Intervention: ESD, with a follow-up endoscopic examination at 8 weeks post-ESD. Univariate and multivariate analyses were used to identify the independent risk factors for delayed healing.Results: Of the 73 gastric neoplasms included in the analysis, delayed ulcer healing was identified in 21.9%. Dyslipidemia (p=0.04), ESD procedure time (p=0.003) and artificial ulcer size (p<0.001) were identified as risk factors for delayed healing, with location in the lower third of the stomach [Odds ratio (OR) 6.76; p=0.016] and artificial ulcer size (OR, 1.18; p=0.024) retained as independent risk factors. A cut-off ulcer size of 854 mm2 was predictive of delayed healing, with a sensitivity of 29.8% and specificity of 87.5%. For large ulcers, the rate of healing of 70% with vonoprazan was higher than the rate of 47.6% with proton pump inhibitors (PPIs), although this difference was not significant.Conclusion: For artificial ulcers after ESD with a resection diameter >35 mm, it might be desirable to use PPIs for >8 weeks or P-CAB.Abbreviations: EGC: early gastric cancers; EMR: endoscopic mucosal resection; ESD: endoscopic submucosal dissection; H. pylori: Helicobacter pylori; H2RA: H2-receptor antagonist: PRP: platelet rich plasma; PGA: polyglycolic acid; P-CAB: potassium-competitive acid blocker; PPI: proton pump inhibitor.

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

“…The remaining 23 articles were retrieved for further review, among which 9 were further excluded due to insufficient data for analysis. Finally, 8 full‐text articles and 6 abstracts, with a total of 1328 patients, were included in the final analysis. The flow diagram of study inclusion is shown in Figure .…”

“…All of the included studies were carried out in Japan during 2016 and 2018. Among these studies, 7 were retrospectively performed and 7 were prospective RCTs . The duration of drug administration in 2 studies was as short as 2 weeks, whereas those in other studies were at least 4 weeks.…”

“…For H. pylori eradication, vonoprazan‐based triple therapy showed superior efficacy and comparable tolerability without increasing the incidence of adverse events compared with the triple therapy including PPIs . As for artificial ulcers after ESD, several studies have compared the efficacy and safety between vonoprazan and PPIs, but the results among studies vary . Therefore, we performed this meta‐analysis to evaluate the therapeutic efficacy and safety of vonoprazan compared with PPIs for treating post‐ESD artificial ulcers.…”

Gastroesophageal Reflux Disease and Erosive-Ulcerative Lesions of the Gastroduodenal Zone in Schoolchildren of Various Ages in Siberia

“…Формирование и прогрессирование ГЭРБ и эрозивноязвенных поражений слизистой оболочки гастродуоденальной зоны в значительной мере связано с агрессией содержимого желудка, обусловленной высокой кислотной продукцией [8,9], что объясняет увеличение сочетания поражения пищевода и гастродуоденальной зоны у взрослых пациентов [10]. Основным патогенетическим звеном является нарушение равновесия агрессивных и защитных факторов желудка с мультифакториальным генезом [11][12][13]. Актуальным является вопрос о взаимосвязи ГЭРБ и эрозивно-язвенных заболеваний желудка и двенадцатиперстной кишки в подростковом и особенно в детском возрасте, для которого физиологически характерен более низкий уровень кислотообразования в желудке [14].…”

Vonoprazan May Provide Better Results than PPIs in Helicobacter Pylori Eradication and Beyond – Is it Time for a Change?

“…The sp e c t r um of VPZ indications has expanded overtime and nowadays it is similar to that of PPIs, including gastroesophageal reflux disease (GERD), gastric and duodenal ulcers healing, management of upper gastrointestinal (GI) bleeding, non-steroidal antiinflammatory drugs (NSAIDs) - submucosal dissection (ESD) [1,3,4]. As to the treatment of GERD, VPZ has been shown to be equally effective as PPIs in various studies using different dosages (5-40 mg) [5,6].…”