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Role of mucoprotective agents in endoscopic submucosal dissection‐derived ulcers: A systematic review
Author(s) -
Pittaya Rapat,
Martel Myriam,
Barkun Alan
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14305
Subject(s) - medicine , endoscopic submucosal dissection , cochrane library , proton pump inhibitor , helicobacter pylori , gastroenterology , randomized controlled trial , meta analysis , surgery
Background Currently, it is still unclear whether adding a mucoprotective agent to a proton pump inhibitor (PPI) results in better outcomes compared with using a PPI alone in patients with post‐gastric endoscopic submucosal dissection (ESD) ulcers. This study aimed to examine the efficacy of PPI alone versus combination treatment in healing of post‐gastric ESD ulcers, as well as on delayed bleeding and amount of blood transfused. Methods A systematic search of MEDLINE, EMBASE, Cochrane, and ISI Web of knowledge databases, up until May 2017, for randomized trials comparing PPI alone versus PPI plus a mucoprotective drug in achieving ulcer healing in patients undergoing gastric ESD was performed. The primary outcome is scarring stage on endoscopic assessment at 4 or 8 weeks after gastric ESD. Results From an initial 3071 citations, eight articles ( n = 953 lesions from 934 patients) were analyzed. Patients receiving combination treatment achieved a scarring stage significantly more often than those on a PPIs alone at 4 or 8 weeks after ESD, (risk ratio = 1.36, 95% CI; 1.06–1.75). No study reported amount of blood transfused. There were no significant between treatment‐group differences in terms of delayed bleeding (risk ratio = 0.58, 95% CI; 0.17–1.99). Neither location of ulcer nor Helicobacter pylori infection was related to ulcer scarring stage. Conclusion The limited evidences suggested combination treatment may be more effective in accelerating the process of ulcer healing in patients undergoing gastric ESD than the use of PPI alone, but does not appear to alter delayed bleeding risk.