Journal of Gastroenterology

, Volume 46, Issue 11, pp 1267–1272

Effect of lansoprazole versus roxatidine on prevention of bleeding and promotion of ulcer healing after endoscopic submucosal dissection for superficial gastric neoplasia

  • Hiroyuki Imaeda
  • Naoki Hosoe
  • Hidekazu Suzuki
  • Yoshimasa Saito
  • Yosuke Ida
  • Rieko Nakamura
  • Yasushi Iwao
  • Haruhiko Ogata
  • Toshifumi Hibi
Original Article—Alimentary Tract

Abstract

Background

Proton pump inhibitors have been reported to be more useful than histamine-2 receptor antagonists for the prevention of bleeding after endoscopic submucosal dissection (ESD) for superficial gastric neoplasia. The aim of this study was to assess the effects of the proton pump inhibitor lansoprazole and the histamine-2 receptor antagonist roxatidine for the prevention of bleeding and the promotion of ulcer healing after ESD and to compare the cost-effectiveness of these two drugs.

Methods

The study subjects were 129 patients who underwent ESD for superficial gastric neoplasia. The patients were randomly assigned to the lansoprazole group (L group) or the roxatidine group (R group). Either drug was administered intravenously from the morning of the ESD day to the day after the ESD, followed by oral treatment for an additional 8 weeks. A second-look endoscopy was performed on the day after the ESD, and a repeat endoscopy was performed at 8 weeks after the ESD. The incidence of bleeding and the ulcer-healing rate at 8 weeks after the ESD were analyzed, as well as the total cost of treatment with these antisecretory agents.

Results

Three patients in each group were excluded from the analysis, leaving 62 patients in L group and 61 in R group. Two of the 62 patients (3.2%) in L group and three of the 61 patients (4.9%) in R group showed bleeding after ESD ; there was no significant difference between the two groups (P = 0.68). The ulcer-healing rate was 93.5% (58/62) in L group and 93.4% (57/61) in R group (P = 1). The total cost of treatment with the antisecretory agent from the day of the ESD to day 56 after the ESD was Yen 13,212 for lansoprazole and Yen 5,841 for roxatidine.

Conclusions

Roxatidine appears to have high cost-effectiveness in the prevention of bleeding and in the promotion of ulcer healing after ESD for superficial gastric neoplasia.

Keywords

Bleeding Ulcer healing Endoscopic submucosal dissection Gastric neoplasia Roxatidine Lansoprazole H2-receptor antagonist Proton pump inhibitor 

References

  1. 1.
    Tada M, Murakami A, Karita M, Yanai H, Okita K. Endoscopic resection of early gastric cancer. Endoscopy. 1993;25:445–50.PubMedCrossRefGoogle Scholar
  2. 2.
    Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc. 1993;39:58–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Kojima T, Parra-Blanco A, Takahashi H, Fujita R. Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc. 1998;48:550–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Yamaguchi Y, Katsumi N, Tauchi M, et al. A prospective randomized trial of either famotidine or omeprazole for the prevention of bleeding after endoscopic mucosal resection and the healing of endoscopic mucosal resection-induced ulceration. Aliment Pharmacol Ther. 2005;21(Suppl 2):111–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48:225–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Oka S, Tanaka S, Kaneko I, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64:877–83.PubMedCrossRefGoogle Scholar
  7. 7.
    Uedo N, Takeuchi Y, Yamada T, et al. Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol. 2007;102:1610–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Jeong HK, Park CH, Jun CH, et al. A prospective randomized trial of either famotidine or pantoprazole for the prevention of bleeding after endoscopic submucosal dissection. J Korean Med Sci. 2007;22:1055–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Ichikawa T, Hotta K, Ishihara K. Second-generation histamine H2-receptor antagonists with gastric mucosal defensive properties. Mini Rev Med Chem. 2009;9:581–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Ichikawa T, Ishihara K, Kusakabe T, Kawakami T, Hotta K. Stimulant effect of nitric oxide generator and roxatidine on mucin biosynthesis of rat gastric oxyntic mucosa. Life Sci. 1999;65:PL41–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Yasutake K, Amano M, Mizokami Y, et al. Effects of changing the type of H2-blocker in the treatment of H2-blocker-resistant ulcers: comparison of roxatidine acetate hydrochloride and other H2-blockers. J Int Med Res. 1998;26:25–36.PubMedGoogle Scholar
  12. 12.
    Heldwein W, Schreiner J, Pedrazzoli J, Lehnert P. Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers? Endoscopy. 1989;21:258–62.PubMedCrossRefGoogle Scholar
  13. 13.
    Oda I, Gotoda T, Hamanaka H, et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc. 2005;17:54–8.CrossRefGoogle Scholar
  14. 14.
    Goto O, Fujishiro M, Kodashima S, et al. A second-look endoscopy after endoscopic submucosal dissection for gastric epithelial neoplasm may be unnecessary: a retrospective analysis of postendoscopic submucosal dissection bleeding. Gastrointest Endosc. 2010;71:241–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Mannen K, Tsunada S, Hara M, et al. Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions. J Gastroenterol. 2010;45:30–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Walt RP, Gomes MD, Wood EC, Logan LH, Pounder RE. Effect of daily oral omeprazole on 24 hour intragastric acidity. Br Med J (Clin Res Ed). 1983;287:12–4.CrossRefGoogle Scholar
  17. 17.
    Shiratsuchi K, Fuse H, Hagiwara M, et al. Cytoprotective action of roxatidine acetate HCl. Arch Int Pharmacodyn Ther. 1988;294:295–304.PubMedGoogle Scholar
  18. 18.
    Ono S, Kato M, Ono Y, et al. Effects of preoperative administration of omeprazole on bleeding after endoscopic submucosal dissection: a prospective randomized controlled trial. Endoscopy. 2009;41:299–303.PubMedCrossRefGoogle Scholar
  19. 19.
    Ye BD, Cheon JH, Choi KD, et al. Omeprazole may be superior to famotidine in the management of iatrogenic ulcer after endoscopic mucosal resection: a prospective randomized controlled trial. Aliment Pharmacol Ther. 2006;24:837–43.PubMedCrossRefGoogle Scholar
  20. 20.
    Kato T, Araki H, Onogi F, et al. Clinical trial: rebamipide promotes gastric ulcer healing by proton pump inhibitor after endoscopic submucosal dissection—a randomized controlled study. J Gastroenterol. 2010;45:285–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Asakuma Y, Kudo M, Matsui S, et al. Comparison of an ecabet sodium and proton pump inhibitor (PPI) combination therapy with PPI alone in the treatment of endoscopic submucosal dissection (ESD)-induced ulcers in early gastric cancer: prospective randomized study. Hepatogastroenterology. 2009;56:1270–3.PubMedGoogle Scholar
  22. 22.
    Kakushima N, Yahagi N, Fujishiro M, et al. The healing process of gastric artificial ulcers after endoscopic submucosal dissection. Dig Endosc. 2004;16:327–31.CrossRefGoogle Scholar
  23. 23.
    Kakushima N, Fujishiro M, Yahagi N, et al. Helicobacter pylori status and the extent of gastric atrophy do not affect ulcer healing after endoscopic submucosal dissection. J Gastroenterol Hepatol. 2006;21:1586–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Hiroyuki Imaeda
    • 1
    • 2
  • Naoki Hosoe
    • 2
  • Hidekazu Suzuki
    • 3
  • Yoshimasa Saito
    • 3
  • Yosuke Ida
    • 3
  • Rieko Nakamura
    • 2
  • Yasushi Iwao
    • 2
  • Haruhiko Ogata
    • 2
  • Toshifumi Hibi
    • 3
  1. 1.Department of General Internal MedicineSaitama Medical UniversitySaitamaJapan
  2. 2.Center for Diagnostic and Therapeutic Endoscopy, School of MedicineKeio UniversityTokyoJapan
  3. 3.Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of MedicineKeio UniversityTokyoJapan

Personalised recommendations