Endoscopy 2019; 51(04): S41
DOI: 10.1055/s-0039-1681291
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ESD stomach 1 Club A
Georg Thieme Verlag KG Stuttgart · New York

WHAT IS THE OPTIMAL DOSE OF PROTON PUMP INHIBITOR AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC EPITHELIAL NEOPLASM?

JY Jang
1   Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea, Republic of
,
JJ Kim
2   Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Endoscopic submucosal dissection (ESD) has become a widely accepted for the en bloc resection of large superficial tumors in the gastrointestinal tract. ESD is less invasive when compared to surgery but complications such as bleeding, perforation and pain can be associated. Proton pump inhibitor (PPI) is frequently used to prevent post ESD bleeding but unlike the bleeding from peptic ulcers, proper dosing for post ESD period is still questionable. We can speculate that high dose PPI infusion would be more effective to ameliorate the post ESD pain. Therefore, this study was conducted to find out optimal dose of PPI in terms of minimizing complications after ESD.

Methods:

We randomly assigned patient as high dose PPI infusion group (Esomeprazole 80 mg i.v. loading → 8 mg/hr for 48 hours) and standard dose PPI group (Esomeprazole 40 mg i.v. daily). After first 48 hours, single dose of oral esomeprazole 40 mg was given to both groups. Prospective analysis was conducted in terms of clinical, endoscopic, and pathologic results from January 2015 to September 2017 at a tertiary teaching hospital.

The primary outcome was rebleeding rate and the use of painkillers such as tramadol and pethidine.

Results:

214 patients were randomly assigned as high dose PPI group and 215 patients were assigned to infuse regular dose PPI. Clinicopathological characteristics of enrolled patients were similar between two groups except location of the tumor. Rebleeding was observed for 13 patients (5.0%) in high dose PPI group and 11 patients (4.5%) for non high dose PPI group respectively. Use of painkiller and maximal VAS (Visual analogue scale) score between two treatment groups also didn't showed significant difference.

Conclusions:

Bleeding rate and post procedural pain reduction was not associated with the use of high dose PPI. Therefore, we concluded that the effect of standard dose PPI is comparable to that of high dose PPI.