Comparative efficacy of various anti-ulcer medications after gastric endoscopic submucosal dissection: a systematic review and network meta-analysis
- Authors
- Kim, Eun Hye; Park, Se Woo; Nam, Eunwoo; Lee, Jae Gon; Park, Chan Hyuk
- Issue Date
- Apr-2019
- Publisher
- SPRINGER
- Keywords
- Endoscopic submucosal dissection; Anti-ulcer medication; Proton-pump inhibitor; Vonoprazan
- Citation
- SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, v.33, no.4, pp.1271 - 1283
- Indexed
- SCIE
SCOPUS
- Journal Title
- SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
- Volume
- 33
- Number
- 4
- Start Page
- 1271
- End Page
- 1283
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/14289
- DOI
- 10.1007/s00464-018-6409-4
- ISSN
- 0930-2794
- Abstract
- BackgroundThe 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.MethodsWe 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 4-8weeks after ESD. A network meta-analysis was performed to calculate the network estimates.ResultsTwenty-one studies with 2005 patients were included. Concerning the comparative efficacy for ulcer healing at 4weeks after ESD, no network inconsistency was identified (Cochran's Q-test, df=10, P=0.13; I-2=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 8weeks 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)].ConclusionsA combination therapy of PPI and muco-protective agent was superior to PPI alone for ulcer healing at 4weeks after ESD. In the ulcer healing effect at 8weeks after ESD, vonoprazan was superior to PPI.
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