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Vonoprazan versus proton pump inhibitors for postendoscopic submucosal dissection bleeding in the stomach: a multicenter population-based comparative study.
Shiratori, Yasutoshi; Niikura, Ryota; Ishii, Naoki; Ikeya, Takashi; Honda, Tetsuro; Hasatani, Kenkei; Yoshida, Naohiro; Nishida, Tsutomu; Sumiyoshi, Tetsuya; Kiyotoki, Shu; Arai, Masahiro; Kawai, Takashi; Fukuda, Katsuyuki.
Afiliação
  • Shiratori Y; Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan.
  • Niikura R; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Gastroenterological Endoscopy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
  • Ishii N; Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan.
  • Ikeya T; Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan.
  • Honda T; Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki-shi, Nagasaki, Japan.
  • Hasatani K; Department of Gastroenterology, Fukui Prefectural Hospital, Fukui-shi, Fukui, Japan.
  • Yoshida N; Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa-shi, Ishikawa, Japan.
  • Nishida T; Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka-shi, Osaka, Japan.
  • Sumiyoshi T; Department of Gastroenterology, Tonan Hospital, Sapporo-shi, Hokkaido, Japan.
  • Kiyotoki S; Department of Gastroenterology, Shuto General Hospital, Yanai-shi, Yamaguchi, Japan.
  • Arai M; Department of Gastroenterology, Nerima Hikarigaoka Hospital, Nerima-ku, Tokyo, Japan.
  • Kawai T; Gastroenterological Endoscopy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
  • Fukuda K; Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan.
Gastrointest Endosc ; 95(1): 72-79.e3, 2022 Jan.
Article em En | MEDLINE | ID: mdl-34237329
BACKGROUND AND AIMS: The effectiveness of vonoprazan relative to that of proton pump inhibitors (PPIs) after gastric endoscopic submucosal dissection (ESD) is unclear. Although previous studies used post-ESD ulcer healing as the outcome measure, post-ESD bleeding rate is the most objective and appropriate outcome measure because it has less ascertainment bias. We aimed to compare the post-ESD bleeding rates between vonoprazan and PPIs. METHODS: This nationwide population-based retrospective cohort study was conducted between 2014 and 2018 and involved 9 hospitals. After 2 days of intravenous PPI administration, either vonoprazan or PPI was administrated from postoperative day 2 to 30. RESULTS: Overall, data of 1715 patients (627 patient pairs) were analyzed through propensity score matching. The vonoprazan group had significantly lower post-ESD bleeding rates than the PPI group (overall, 11.9% vs 17.2%, P = .008; bleeding between days 2 and 30, 7.8% vs 11.8%, P = .015). The readmission rate because of post-ESD bleeding was lower in the vonoprazan group (2.4% vs 4.1%, P = .081). Blood transfusion (2.1% vs 3.0%, P = .15) and additional surgery because of delayed perforation (.5% vs 1.0%, P = .32) were not significantly different between the 2 groups. No deaths within 30 days occurred in both groups. On Cox regression analysis, vonoprazan use, lesion location (antrum), aspirin use, direct oral anticoagulant use, and Charlson Comorbidity Index (≥2) were associated with an increased risk of post-ESD bleeding within 30 days. CONCLUSIONS: Vonoprazan has a lower post-ESD bleeding rate than PPIs. Further prospective studies are required to confirm these results.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Gástricas / Úlcera Gástrica / Ressecção Endoscópica de Mucosa Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Gástricas / Úlcera Gástrica / Ressecção Endoscópica de Mucosa Idioma: En Ano de publicação: 2022 Tipo de documento: Article