Korean J Gastroenterol.  2016 Feb;67(2):74-80. 10.4166/kjg.2016.67.2.74.

Comparison on Oral versus Intravenous Proton Pump Inhibitors for Prevention of Bleeding after Endoscopic Submucosal Dissection of Gastric Lesions

• Jung YS
• Kim KO
• Lee SH
• Jang BI
• Kim TN

• KMID: 2383544
• DOI: http://doi.org/10.4166/kjg.2016.67.2.74

Abstract

BACKGROUND/AIMS
Although intravenous proton pump inhibitor (PPI) has been used for the prevention of post endoscopic submucosal dissection (ESD) bleeding, the route of administration has not been confirmed. The aim of the present study was to compare the efficacy of intravenous and oral PPI administration for the prevention of delayed post ESD bleeding.
METHODS
Total 166 consecutive patients were randomly assigned to 30 mg lansoprazol twice a day (PO group) and 120 mg pantoprazole intravenous injection (IV group) for 48 hours. Finally, 65 patients in PO group and 87 patients in IV group were analyzed. After ESD, all patients underwent follow up endoscopy after 24 hours and were observed the symptoms of bleeding up to 60 days after ESD.
RESULTS
Age, sex and use of anticoagulants were not different between groups. At follow up endoscopy after 24 hours, oozing and exposed vessel was noted in 4.6% of PO group and 8.0% of IV group and there was no significant difference. Delayed bleeding occurred in 4 of 65 patients (6.2%) in the PO group and 8 of 87 patients (9.2%) in the IV group (p>0.999). By multivariate analysis, oozing or exposed vessels at follow up endoscopy were risk factors for delayed bleeding (OR=17.5, p=0.022).
CONCLUSIONS
There was no significant difference in the delayed bleeding, length of hospital stay according to the administration route. Bleeding stigmata at follow up endoscopy was risk factor of delayed bleeding. Oral PPI administration can cost-effectively replace IV PPI for prevention of post ESD bleeding.

Keyword

Endoscopic submucosal dissection; Proton pump inhibitors; Hemorrhage

MeSH Terms

2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use
*Administration, Oral
Aged
Anticoagulants/therapeutic use
Endoscopic Mucosal Resection/*adverse effects
Female
Gastroscopy
Humans
*Injections, Intravenous
Lansoprazole/therapeutic use
Male
Middle Aged
Odds Ratio
Postoperative Hemorrhage/etiology/*prevention & control
Prospective Studies
Proton Pump Inhibitors/*therapeutic use
Risk Factors
Stomach Neoplasms/surgery
2-Pyridinylmethylsulfinylbenzimidazoles
Anticoagulants
Proton Pump Inhibitors
Lansoprazole

Figure

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  Fig. 1. Treatment protocol of the groups. POD, post-operative day; PO, per oral; IV, intravenous; ESD, endoscopic submucosal dissection; bid, twice a day; qd, once a day.

• 

  Fig. 2. Flow chart of study participants. PO, per oral; IV, intravenous; PPI, proton pump inhibitor; f/u, follow up.

Reference

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