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

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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.

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References

  1. Park CH, Shin S, Park JC, Shin SK, Lee SK, Lee YC, Lee H (2013) Long-term outcome of early gastric cancer after endoscopic submucosal dissection: expanded indication is comparable to absolute indication. Dig Liver Dis 45:651–656

    Article  PubMed  Google Scholar 

  2. Park CH, Min JH, Yoo Y, Kim H, Joh DH, Jo JH, Lee H, Park JC, Shin SK, Lee YC, Lee SK (2013) Sedation methods can determine performance of endoscopic submucosal dissection in patients with gastric neoplasia. Surg Endosc 27:2760–2767

    Article  PubMed  Google Scholar 

  3. Park CH, Lee SK (2013) Preventing and controlling bleeding in gastric endoscopic submucosal dissection. Clin Endosc 46:456–462

    Article  PubMed  PubMed Central  Google Scholar 

  4. Park CH, Park JC, Lee H, Shin SK, Lee SK, Lee YC (2015) Second-look endoscopy after gastric endoscopic submucosal dissection for reducing delayed postoperative bleeding. Gut Liver 9:43–51

    Article  PubMed  Google Scholar 

  5. Kim EH, Park SW, Nam E, Eun CS, Han DS, Park CH (2017) Role of second-look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection: a systematic review and meta-analysis. J Gastroenterol Hepatol 32:756–768

    Article  CAS  PubMed  Google Scholar 

  6. Yang Z, Wu Q, Liu Z, Wu K, Fan D (2011) Proton pump inhibitors versus histamine-2-receptor antagonists for the management of iatrogenic gastric ulcer after endoscopic mucosal resection or endoscopic submucosal dissection: a meta-analysis of randomized trials. Digestion 84:315–320

    Article  CAS  PubMed  Google Scholar 

  7. Sakurai Y, Mori Y, Okamoto H, Nishimura A, Komura E, Araki T, Shiramoto M (2015) Acid-inhibitory effects of vonoprazan 20 mg compared with esomeprazole 20 mg or rabeprazole 10 mg in healthy adult male subjects–a randomised open-label cross-over study. Aliment Pharmacol Ther 42:719–730

    Article  CAS  PubMed  Google Scholar 

  8. Hori Y, Imanishi A, Matsukawa J, Tsukimi Y, Nishida H, Arikawa Y, Hirase K, Kajino M, Inatomi N (2010) 1-[5-(2-Fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamin e monofumarate (TAK-438), a novel and potent potassium-competitive acid blocker for the treatment of acid-related diseases. J Pharmacol Exp Ther 335:231–238

    Article  CAS  PubMed  Google Scholar 

  9. Ashida K, Sakurai Y, Nishimura A, Kudou K, Hiramatsu N, Umegaki E, Iwakiri K, Chiba T (2015) Randomised clinical trial: a dose-ranging study of vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the treatment of erosive oesophagitis. Aliment Pharmacol Ther 42:685–695

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ashida K, Sakurai Y, Hori T, Kudou K, Nishimura A, Hiramatsu N, Umegaki E, Iwakiri K (2016) Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment Pharmacol Ther 43:240–251

    Article  CAS  PubMed  Google Scholar 

  11. Miwa H, Uedo N, Watari J, Mori Y, Sakurai Y, Takanami Y, Nishimura A, Tatsumi T, Sakaki N (2017) Randomised clinical trial: efficacy and safety of vonoprazan vs. lansoprazole in patients with gastric or duodenal ulcers - results from two phase 3, non-inferiority randomised controlled trials. Aliment Pharmacol Ther 45:240–252

    Article  CAS  PubMed  Google Scholar 

  12. Kagawa T, Iwamuro M, Ishikawa S, Ishida M, Kuraoka S, Sasaki K, Sakakihara I, Izumikawa K, Yamamoto K, Takahashi S, Tanaka S, Matsuura M, Hasui T, Wato M, Inaba T (2016) Vonoprazan prevents bleeding from endoscopic submucosal dissection-induced gastric ulcers. Aliment Pharmacol Ther 44:583–591

    Article  CAS  PubMed  Google Scholar 

  13. Nishizawa T, Suzuki H, Kanai T, Yahagi N (2015) Proton pump inhibitor alone vs proton pump inhibitor plus mucosal protective agents for endoscopic submucosal dissection-induced ulcer: a systematic review and meta-analysis. J Clin Biochem Nutr 56:85–90

    Article  CAS  PubMed  Google Scholar 

  14. Takahashi K, Sato Y, Kohisa J, Watanabe J, Sato H, Mizuno K, Hashimoto S, Terai S (2016) Vonoprazan 20 mg vs lansoprazole 30 mg for endoscopic submucosal dissection-induced gastric ulcers. World J Gastrointest Endosc 8:716–722

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tsuchiya I, Kato Y, Tanida E, Masui Y, Kato S, Nakajima A, Izumi M (2017) Effect of vonoprazan on the treatment of artificial gastric ulcers after endoscopic submucosal dissection: prospective randomized controlled trial. Dig Endosc 29:576–583

    Article  PubMed  Google Scholar 

  16. Takayama M, Matsui S, Kawasaki M, Asakuma Y, Sakurai T, Kashida H, Kudo M (2013) Efficacy of treatment with rebamipide for endoscopic submucosal dissection-induced ulcers. World J Gastroenterol 19:5706–5712

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Kim YJ, Cheon JH, Lee SK, Kim JH, Lee YC (2010) Rebamipide may be comparable to H2 receptor antagonist in healing iatrogenic gastric ulcers created by endoscopic mucosal resection: a prospective randomized pilot study. J Korean Med Sci 25:583–588

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Ahn JY, Choi CH, Lee JW, Park SJ, Kim JW, Chang SK, Han SB (2015) The effect of sequential therapy with lansoprazole and ecabet sodium in treating iatrogenic gastric ulcer after endoscopic submucosal dissection: a randomized prospective study. J Dig Dis 16:75–82

    Article  CAS  PubMed  Google Scholar 

  19. Park CH, Jung YS, Nam E, Eun CS, Park DI, Han DS (2016) Comparison of efficacy of prophylactic endoscopic therapies for postpolypectomy bleeding in the colorectum: a systematic review and network meta-analysis. Am J Gastroenterol 111:1230–1243

    Article  PubMed  Google Scholar 

  20. Hoaglin DC, Hawkins N, Jansen JP, Scott DA, Itzler R, Cappelleri JC, Boersma C, Thompson D, Larholt KM, Diaz M, Barrett A (2011) Conducting indirect-treatment-comparison and network-meta-analysis studies: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 2. Value Health 14:429–437

    Article  PubMed  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  PubMed  Google Scholar 

  22. Jansen JP, Fleurence R, Devine B, Itzler R, Barrett A, Hawkins N, Lee K, Boersma C, Annemans L, Cappelleri JC (2011) Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR task force on indirect treatment comparisons good research practices: part 1. Value Health 14:417–428

    Article  PubMed  Google Scholar 

  23. Higgins J, Green S (2016) Cochrnae handbook for systematic reviews of interventions, Version 5.1.0, Chap. 8: assessing risk of bias in included studies. http://handbook.cochrane.org/chapter_8/8_assessing_risk_of_bias_in_included_studies.htm. Accessed 31 Dec 2016

  24. Puhan MA, Schunemann HJ, Murad MH, Li T, Brignardello-Petersen R, Singh JA, Kessels AG, Guyatt GH, Group GW (2014) A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ 349:g5630

    Article  PubMed  Google Scholar 

  25. Higgins JP, Thompson SG, Deeks J, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  26. Higgins J, Green S (2016) Cochrane handbook for systematic reviews of interventions, Version 5.1.0, Chap. 10.4.3.1 Recommendations on testing for funnel plot asymmetry. http://handbook.cochrane.org/chapter_10/10_4_3_1_recommendations_on_testing_for_funnel_plot_asymmetry.htm. Accessed 31 Dec 2016

  27. Rucker G (2012) Network meta-analysis, electrical networks and graph theory. Res Synth Methods 3:312–324

    Article  PubMed  Google Scholar 

  28. Rucker G, Schwarzer G (2015) Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med Res Methodol 15:58

    Article  PubMed  PubMed Central  Google Scholar 

  29. Li H, Li X (2015) Effect of teprenone combined with rabeprazole on prevention of bleeding after gastric ESD. Chin J Gastroenterol 20:546–549

    Google Scholar 

  30. Yamaguchi Y, Katsumi N, Tauchi M, Toki M, Nakamura K, Aoki K, Morita Y, Miura M, Morozumi K, Ishida H, Takahashi S (2005) 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 21(Suppl 2):111–115

    Article  CAS  PubMed  Google Scholar 

  31. Uedo N, Takeuchi Y, Yamada T, Ishihara R, Ogiyama H, Yamamoto S, Kato M, Tatsumi K, Masuda E, Tamai C, Higashino K, Iishi H, Tatsuta M (2007) 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 102:1610–1616

    Article  CAS  PubMed  Google Scholar 

  32. Asakuma Y, Kudo M, Matsui S, Okada M, Kawasaki M, Umehara Y, Ichikawa T, Kitai S (2009) 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 56:1270–1273

    CAS  PubMed  Google Scholar 

  33. Inaba T, Ishikawa S, Toyokawa T, Ishikawa H, Miyahara K, Wato M, Kawai K, Okada H, Yamamoto K (2010) Basal protrusion of ulcers induced by endoscopic submucosal dissection (ESD) during treatment with proton pump inhibitors, and the suppressive effects of polaprezinc. Hepatogastroenterology 57:678–684

    CAS  PubMed  Google Scholar 

  34. Kato T, Araki H, Onogi F, Ibuka T, Sugiyama A, Tomita E, Nagaki M, Moriwaki H (2010) Clinical trial: rebamipide promotes gastric ulcer healing by proton pump inhibitor after endoscopic submucosal dissection–a randomized controlled study. J Gastroenterol 45:285–290

    Article  CAS  PubMed  Google Scholar 

  35. Ohya TR, Endo H, Kawagoe K, Yanagawa T, Hanawa K, Ohata K, Asayama M, Hisatomi K, Teratani T, Gunji T, Sato H, Matsuhashi N (2010) A prospective randomized trial of lafutidine vs rabeprazole on post-ESD gastric ulcers. World J Gastrointest Endosc 2:36–40

    Article  PubMed  PubMed Central  Google Scholar 

  36. Fujiwara S, Morita Y, Toyonaga T, Kawakami F, Itoh T, Yoshida M, Kutsumi H, Azuma T (2011) A randomized controlled trial of rebamipide plus rabeprazole for the healing of artificial ulcers after endoscopic submucosal dissection. J Gastroenterol 46:595–602

    Article  CAS  PubMed  Google Scholar 

  37. Imaeda H, Hosoe N, Suzuki H, Saito Y, Ida Y, Nakamura R, Iwao Y, Ogata H, Hibi T (2011) Effect of lansoprazole versus roxatidine on prevention of bleeding and promotion of ulcer healing after endoscopic submucosal dissection for superficial gastric neoplasia. J Gastroenterol 46:1267–1272

    Article  CAS  PubMed  Google Scholar 

  38. Araki H, Kato T, Onogi F, Ibuka T, Sugiyama A, Nakanishi T, Sugiyama T, Tomita E, Moriwaki H (2012) Combination of proton pump inhibitor and rebamipide, a free radical scavenger, promotes artificial ulcer healing after endoscopic submucosal dissection with dissection size> 40 mm. J Clin Biochem Nutr 51:185–188

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Kobayashi M, Takeuchi M, Hashimoto S, Mizuno K, Sato Y, Narisawa R, Aoyagi Y (2012) Contributing factors to gastric ulcer healing after endoscopic submucosal dissection including the promoting effect of rebamipide. Dig Dis Sci 57:119–126

    Article  CAS  PubMed  Google Scholar 

  40. Matsui S, Kudo M, Kashida H, Asakuma Y, Sakurai T, Kawasaki M (2012) Effect of rebamipide for endoscopic submucosal dissection (ESD)-induced ulcer in early gastric cancer: a randomized controlled trial. Gastrointest Endosc 75:AB237

    Article  Google Scholar 

  41. Shin WG, Kim SJ, Choi MH, Kim KO, Jang HJ, Park CH, Baek IH, Kim KH, Baik GH, Kae SH, Kim JH, Kim HY (2012) Can rebamipide and proton pump inhibitor combination therapy promote the healing of endoscopic submucosal dissection-induced ulcers? A randomized, prospective, multicenter study. Gastrointest Endosc 75:739–747

    Article  PubMed  Google Scholar 

  42. Tomita T, Kim Y, Yamasaki T, Okugawa T, Kondo T, Toyoshima F, Sakurai J, Tanaka J, Morita T, Oshima T, Fukui H, Hori K, Watari J, Matsumoto T, Miwa H (2012) Prospective randomized controlled trial to compare the effects of omeprazole and famotidine in preventing delayed bleeding and promoting ulcer healing after endoscopic submucosal dissection. J Gastroenterol Hepatol 27:1441–1446

    Article  CAS  PubMed  Google Scholar 

  43. Miyahara R, Funasaka K, Furukawa K, Ohashi A, Ando N, Otsuka Y, Kamioka T, Yamamoto H, Miyata A, Sasaki Y, Nagaya T, Hisanaga Y, Kitabatake S, Kobayashi M, Itoh A, Ohimiya N, Ando T, HIrooka Y, Goto H (2013) Can irsogladine maleate, a mucosal protective drug, promotes the healing of ulcers after endoscopic submucosal dissection? A randomized, prospective, multicenter study. Gastrointest Endosc 77:AB124

    Article  Google Scholar 

  44. Nakamura M, Tahara T, Shiroeda H, Matsunaga K, Otsuka T, Yonemura J, Shibata T, Arisawa T (2015) The effect of short-term proton pump inhibitor plus anti-ulcer drug on the healing of endoscopic submucosal dissection-derived artificial ulcer: a randomized controlled trial. Hepatogastroenterology 62:219–224

    CAS  PubMed  Google Scholar 

  45. Nakamura K, Ihara E, Akiho H, Akahoshi K, Harada N, Ochiai T, Nakamura N, Ogino H, Iwasa T, Aso A, Iboshi Y, Takayanagi R (2016) Limited effect of rebamipide in addition to proton pump inhibitor (PPI) in the treatment of post-endoscopic submucosal dissection gastric ulcers: a randomized controlled trial comparing PPI plus rebamipide combination therapy with PPI monotherapy. Gut Liver 10:917–924

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Ban H, Sugimoto M, Otsuka T, Inatomi O, Bamba S, Andoh A (2017) Advantage of potassium-competitive acid blocker to healing of artificial ulcer after endoscopic submucosal dissection: prospective randomized trial. Gastroenterology 152:S254

    Article  Google Scholar 

  47. Olbe L, Carlsson E, Lindberg P (2003) A proton-pump inhibitor expedition: the case histories of omeprazole and esomeprazole. Nat Rev Drug Discov 2:132–139

    Article  CAS  PubMed  Google Scholar 

  48. Jung YS, Kim EH, Park CH (2017) Systematic review with meta-analysis: the efficacy of vonoprazan-based triple therapy on Helicobacter pylori eradication. Aliment Pharmacol Ther 46:106–114

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

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

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea

    Eun Hye Kim

  2. Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Republic of Korea

    Se Woo Park

  3. Biostatistical Consulting and Research Lab, Medical Research Coordinating Center, Hanyang University, Seoul, Republic of Korea

    Eunwoo Nam

  4. Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea

    Jae Gon Lee & Chan Hyuk Park

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  1. Eun Hye Kim
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Correspondence to Chan Hyuk Park.

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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.

Electronic supplementary material

Appendix: Detailed search strategy

Appendix: Detailed search strategy

MEDLINE

(ESD[Title/Abstract] OR endoscopic submucosal dissection[Title/Abstract] OR EMR[Title/Abstract] OR endoscopic mucosal resection[Title/Abstract] OR endoscopic resection[Title/Abstract] OR iatrogenic[Title/Abstract] OR artificial[Title/Abstract]) AND (ulcer*[Title/Abstract]) AND (vonoprazan[Title/Abstract] OR TAK-438[Title/Abstract] OR revaprazan[Title/Abstract] OR YH1885[Title/Abstract] OR (potassium[Title/Abstract] AND competitive[Title/Abstract]) OR potassium-competitive[Title/Abstract] OR ppi[Title/Abstract] OR proton pump inhibitor*[Title/Abstract] OR dexlansoprazole[Title/Abstract] or esomeprazole[Title/Abstract] OR ilaprazole[Title/Abstract] OR lansoprazole[Title/Abstract] OR omeprazole[Title/Abstract] OR pantoprazole[Title/Abstract] OR rabeprazole[Title/Abstract] OR ((histamine[Title/Abstract] OR histamine2[Title/Abstract] OR histamine-2[Title/Abstract] OR h2[Title/Abstract] OR h-2[Title/Abstract]) AND (antagonist*[Title/Abstract] OR blocker*[Title/Abstract])) OR h2ra[Title/Abstract] OR famotidine[Title/Abstract] OR cimetidine[Title/Abstract] OR ranitidine[Title/Abstract] OR nizatidine[Title/Abstract] OR lafutidine[Title/Abstract] OR misoprostol[Title/Abstract] OR rebamipide[Title/Abstract] OR ecabet[Title/Abstract] OR irsogladine[Title/Abstract] OR polaprezinc[Title/Abstract] OR muco-protective[Title/Abstract] OR mucoprotective[Title/Abstract]) AND (“1990/01/01”[Date—Publication] : “2017/10/31”[Date—Publication]).

EMBASE

(ESD:ab,ti OR ‘endoscopic submucosal dissection’:ab,ti OR EMR:ab,ti OR ‘endoscopic mucosal resection’:ab,ti OR ‘endoscopic resection’:ab,ti OR iatrogenic:ab,ti OR artificial:ab,ti) AND (ulcer*:ab,ti) AND (vonoprazan:ab,ti OR TAK-438:ab,ti OR revaprazan:ab,ti OR YH1885:ab,ti OR (potassium:ab,ti AND competitive:ab,ti) OR potassium-competitive:ab,ti OR ppi:ab,ti OR proton pump inhibitor*:ab,ti OR dexlansoprazole:ab,ti or esomeprazole:ab,ti OR ilaprazole:ab,ti OR lansoprazole:ab,ti OR omeprazole:ab,ti OR pantoprazole:ab,ti OR rabeprazole:ab,ti OR ((histamine:ab,ti OR histamine2:ab,ti OR histamine-2:ab,ti OR h2:ab,ti OR h-2:ab,ti) AND (antagonist*:ab,ti OR blocker*:ab,ti)) OR h2ra:ab,ti OR famotidine:ab,ti OR cimetidine:ab,ti OR ranitidine:ab,ti OR nizatidine:ab,ti OR lafutidine:ab,ti OR misoprostol:ab,ti OR rebamipide:ab,ti OR ecabet:ab,ti OR irsogladine:ab,ti OR polaprezinc:ab,ti OR muco-protective:ab,ti OR mucoprotective:ab,ti) AND [1990–2017]/py AND [embase]/lim.

Cochrane

  1. 1.

    ESD or “endoscopic submucosal dissection” or EMR or “endoscopic mucosal resection” or “endoscopic resection” or iatrogenic or artificial

  2. 2.

    ulcer*

  3. 3.

    vonoprazan or TAK-438 or revaprazan or YH1885

  4. 4.

    potassium and competitive

  5. 5.

    ppi or ‘proton pump inhibitor*’ or dexlansoprazole or esomeprazole or ilaprazole or lansoprazole or omeprazole or pantoprazole or rabeprazole

  6. 6.

    histamine or histamine2 or histamine-2 or h2 or h-2

  7. 7.

    antagonist* or blocker*

  8. 8.

    h2ra or famotidine or cimetidine or ranitidine or nazatidine or lafutidine

  9. 9.

    misoprostol or rebamipide or ecabet or irsogladine or polaprezinc or muco-protective or mucoprotective

  10. 10.

    #3 or #4

  11. 11.

    #6 and #7

  12. 12.

    #11 or #8

  13. 13.

    #10 or #5 or #12 or #9

  14. 14.

    #1 and #2 and #13 (Publication year from 1990 to 2017)

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Kim, E.H., Park, S.W., Nam, E. et al. Comparative efficacy of various anti-ulcer medications after gastric endoscopic submucosal dissection: a systematic review and network meta-analysis. Surg Endosc 33, 1271–1283 (2019). https://doi.org/10.1007/s00464-018-6409-4

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