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Optimal duration of proton pump inhibitor in the treatment of endoscopic submucosal dissection-induced ulcers: a retrospective analysis and prospective validation study.

AbstractBACKGROUND:
The optimal duration of proton pump inhibitor (PPI) use in the treatment of endoscopic submucosal dissection (ESD)-induced ulcers has not been well defined.
AIMS:
The aim of study was to determine the optimal duration of PPI treatment for ESD-induced gastric ulcers.
METHODS:
A total of 333 patients who underwent ESD were included in this retrospective analysis and prospective randomized validation. Medical records and endoscopic images for the 221 patients in our ESD-database were reviewed retrospectively. Based on the results of the retrospective analysis, 112 patients with ESD-induced ulcers over 40 mm were randomly assigned to two groups (4- or 8-week course of Lansoprazole 30 mg). Main outcome measurements were to assess the healing-related factors of post-ESD ulcers (retrospective analysis) and to compare complete mucosal healing rate in large (≥ 40 mm) ESD-induced ulcers according to the duration of PPI treatment (prospective validation).
RESULTS:
Multivariate logistic regression from a retrospective analysis showed that a duration of PPI treatment <8 weeks and a post-ESD ulcer ≥ 40 mm in size were associated with incomplete healing. In a prospective validation, the rate of complete healing in the 8-week PPI group was significantly higher than that of the 4-week PPI group for a large (≥ 40 mm) ESD-induced ulcer at 8 weeks follow-up (83.3 vs. 42.6%, P < 0.01).
CONCLUSIONS:
The optimal duration of PPI treatment varies based on the initial ulcer size. Patients with an ESD-induced ulcer over 40 mm should be treated with an 8-week course of PPIs.
AuthorsSuck-Ho Lee, Chang Kyun Lee, Il-Kwun Chung, Yun Suk Shim, Tae Hoon Lee, Sae Hwan Lee, Hong-Soo Kim, Sang-Heum Park, Sun-Joo Kim
JournalDigestive diseases and sciences (Dig Dis Sci) Vol. 57 Issue 2 Pg. 429-34 (Feb 2012) ISSN: 1573-2568 [Electronic] United States
PMID22001942 (Publication Type: Journal Article, Randomized Controlled Trial)
Chemical References
  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Enzyme Inhibitors
  • Proton Pump Inhibitors
  • Lansoprazole
Topics
  • 2-Pyridinylmethylsulfinylbenzimidazoles (administration & dosage)
  • Aged
  • Dissection (methods)
  • Endoscopy, Gastrointestinal (adverse effects, methods)
  • Enzyme Inhibitors (administration & dosage)
  • Female
  • Humans
  • Lansoprazole
  • Logistic Models
  • Male
  • Middle Aged
  • Proton Pump Inhibitors (administration & dosage)
  • Retrospective Studies
  • Stomach Neoplasms (surgery)
  • Stomach Ulcer (drug therapy, etiology)
  • Wound Healing (drug effects)

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