Randomized Controlled Trial
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World J Gastroenterol. Nov 21, 2014; 20(43): 16318-16322
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16318
Two-week treatment with proton pump inhibitor is sufficient for healing post endoscopic submucosal dissection ulcers
Makoto Arai, Tomoaki Matsumura, Kenichiro Okimoto, Arata Oyamada, Keiko Saito, Shoko Minemura, Daisuke Maruoka, Takeshi Tanaka, Tomoo Nakagawa, Tatsuro Katsuno, Osamu Yokosuka
Makoto Arai, Tomoaki Matsumura, Kenichiro Okimoto, Arata Oyamada, Keiko Saito, Shoko Minemura, Daisuke Maruoka, Takeshi Tanaka, Tomoo Nakagawa, Tatsuro Katsuno, Osamu Yokosuka, Department of Gastroenterology and Nephrology (K1), Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
Author contributions: Arai M designed research and wrote the paper; Matsumura T, Okimoto K, Oyamada A, Saito K, Minemura S, Maruoka D, Tanaka T, Nakagawa T and Katsuno K performed endoscopic treatment and examinations; Yokosuka O analyzed data.
Supported by Grant support from Daiichi Sankyo Co., Ltd., AstraZeneca Co., Ltd., and Otsuka Pharmaceutical Co., Ltd (To Yokosuka O); and the lecture fees from Daiichi Sankyo, AstraZeneca (To Arai M)
Correspondence to: Makoto Arai, MD, Department of Gastroenterology and Nephrology (K1), Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba-City 260-8670, Japan. araim-cib@umin.ac.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: October 28, 2013
Revised: June 4, 2014
Accepted: June 25, 2014
Published online: November 21, 2014
Processing time: 221 Days and 1.8 Hours
Abstract

AIM: To investigate the optimum period of treatment for post endoscopic submucosal dissection (ESD) ulcers.

METHODS: Patients who underwent ESD for gastric cancer were randomized to two groups and treated with esomeprazole 20 mg per day for 4 wk (4W group) or 2 wk (2W group). At 4 wk after ESD, we measured the size of the artificial ulcers by endoscopy and determined the ulcer healing rate, compared with the size of the ESD specimens. This randomized controlled trial study was approved by our ethics committee and registered in the UMIN Clinical Trial Registry.

RESULTS: A total of 60 consecutive patients were included in the study. All patients received rebamipide 300 mg per day for 4 wk. One patient in 2W group who showed bleeding within two weeks and received endoscopic treatment was excluded from further analysis. The numbers of patients with ulcers in the healing/scar stage in the 2W and 4W groups at 4 wk after ESD were 20/6 and 28/5, respectively, with no significant difference. The ulcer healing rate in the 2W and 4W groups were 96.1% [95% confidence interval (CI): 94.6%-97.55] vs 94.8% (95%CI: 92.6%-97.1%), respectively, with no statistical difference (UMIN000006951).

CONCLUSION: Two-wk treatment with a proton pump inhibitor is as effective as four-week treatment for healing post ESD ulcers.

Keywords: Proton pump inhibitor; Endoscopic submucosal dissection; Esomeprazole; Rebamipide; Randomized control trial

Core tip: There is no consensus regarding the optimum period of treatment of patients with post endoscopic submucosal dissection (ESD) ulcers. 60 patients who underwent ESD for gastric cancer were randomized to two groups and treated with proton pump inhibitor for 4 wk (4W group) or 2 wk (2W group). The numbers of patients with ulcers in the healing/scar stage and the ulcer healing rate at 4 wk after ESD showed no statistical difference between 2W and 4W groups. Two-week treatment with a proton pump inhibitor is as effective as four-week treatment for healing post ESD ulcers.