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Comparative efficacy of various anti-ulcer medications after gastric endoscopic submucosal dissection: a systematic review and network meta-analysis

  • Eun Hye Kim
  • Se Woo Park
  • Eunwoo Nam
  • Jae Gon Lee
  • Chan Hyuk Park
Article
  • 198 Downloads

Abstract

Background

The comparative efficacy of various anti-ulcer medications after gastric endoscopic submucosal dissection (ESD) has not been fully evaluated. Recently, vonoprazan, a novel potassium-competitive acid blocker, has also been used in ulcer treatment after ESD.

Methods

We searched for all relevant randomized controlled trials examining the efficacy of anti-ulcer medications after gastric ESD, published through October 2017. Healing of iatrogenic ulcers was investigated at 4–8 weeks after ESD. A network meta-analysis was performed to calculate the network estimates.

Results

Twenty-one studies with 2005 patients were included. Concerning the comparative efficacy for ulcer healing at 4 weeks after ESD, no network inconsistency was identified (Cochran’s Q-test, df = 10, P = 0.13; I2 = 34%). A combination therapy of proton-pump inhibitor (PPI) and muco-protective agent was superior to PPI alone [risk ratio (RR) (95% confidence interval, CI) 1.69 (1.20–2.39)]. The combination therapy of PPI and muco-protective agents tended to be superior to vonoprazan [RR (95% CI) 1.98 (0.99–3.94)]. There was no difference of ulcer healing effect between PPI and vonoprazan [RR (95% CI) PPI vs. vonoprazan, 1.17 (0.64–2.12)]. Concerning the ulcer healing rate at 8 weeks after ESD, however, vonoprazan was superior to PPI [RR (95% CI) 1.27 (1.03–1.56)]. Additionally, vonoprazan tended to be superior to the combination therapy of PPI and muco-protective agent [RR (95% CI) 1.20 (0.96–1.51)].

Conclusions

A combination therapy of PPI and muco-protective agent was superior to PPI alone for ulcer healing at 4 weeks after ESD. In the ulcer healing effect at 8 weeks after ESD, vonoprazan was superior to PPI.

Keywords

Endoscopic submucosal dissection Anti-ulcer medication Proton-pump inhibitor Vonoprazan 

Notes

Acknowledgements

This work was supported by the research fund of Hanyang University (HY-2017).

Compliance with ethical standards

Disclosures

Eun Hye Kim, Se Woo Park, Eunwoo Nam, Jae Gon Lee, and Chan Hyuk Park have no conflicts of interest or financial ties to disclose.

Supplementary material

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of GastroenterologyYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart HospitalHallym University College of MedicineHwasungRepublic of Korea
  3. 3.Biostatistical Consulting and Research Lab, Medical Research Coordinating CenterHanyang UniversitySeoulRepublic of Korea
  4. 4.Department of Internal Medicine, Hanyang University Guri HospitalHanyang University College of MedicineGuriRepublic of Korea

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