Endoscopic submucosal dissection (ESD) has been reported to have a higher
bleeding rate than conventional methods. However, there are few reports on whether a
proton pump inhibitor or a histamine2-receptor antagonist is the more effective treatment for preventing
bleeding after ESD. In a prospective trial, patients undergoing ESD due to gastric
adenoma or
adenocarcinoma were randomly assigned to
pantoprazole or
famotidine. Both drugs were given intravenously for the first 2 days, thereafter by mouth. Eighty-five in the
pantoprazole group and 79 in the
famotidine group were included for analysis. Primary outcome measure was the delayed
bleeding rate. Clinical characteristics were not different between the two groups. The delayed
bleeding rate was significantly lower in the
pantoprazole group compared with the
famotidine group (3.5% vs. 12.7%, p=0.031). On multivariate analysis, the preventive use of
pantoprazole (relative hazard: 0.220, 95% CI: 0.051- 0.827, p=0.026) and the specimen size (> or =34 mm, relative hazard: 4.178, 95% CI: 1.229-14.197, p=0.022) were two independent factors predictive of delayed
bleeding. There were no significant differences in en bloc and complete resection rate between the two groups. In conclusion,
pantoprazole is more effective than
famotidine for the prevention of delayed
bleeding after ESD.