Skip to main content

Advertisement

SpringerLink
Log in

Proton pump inhibitor after endoscopic resection for esophageal squamous cell cancer: multicenter prospective randomized controlled trial

  • Original Article—Alimentary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Whether proton pump inhibitors (PPIs) relieve heartburn or precordial pain after endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of this study was to investigate the efficacy of PPI therapy for these symptoms after ER for ESCC.

Methods

We conducted a multicenter prospective randomized controlled trial among 15 hospitals in Japan. In total, 229 patients with cT1a ESCC were randomly assigned to receive PPI therapy for 5 weeks after ER (the PPI group, n = 115) or follow-up without PPI therapy (the non-PPI group, n = 114). The primary end point was the incidence of gastroesophageal reflux disease (GERD)-like symptoms after ER from a self-reported questionnaire (Frequency Scale for Symptoms of GERD). Secondary end points were ulcer healing rate at 5 weeks, incidence of pain, improvement rate of symptoms in those who started PPI therapy because of GERD-like symptoms in the non-PPI group, and adverse events.

Results

No significant difference was observed in the incidence of GERD-like symptoms after ER between the non-PPI and PPI groups (30 % vs 34 %, respectively). No significant differences were observed in the ulcer healing rate at 5 weeks (84 % vs 85 %) and incidence of pain within 1 week (36 % vs 45 %). In nine of ten patients (90 %) who started PPI therapy because of GERD-like symptoms in the non-PPI group, PPI administration relieved GERD-like symptoms. No adverse events related to PPI administration were observed.

Conclusion

PPI therapy is not efficacious in reducing symptoms and did not promote healing of ulcers in patients undergoing ER for ESCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48:225–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Kakushima N, Fujishiro M. Endoscopic submucosal dissection for gastrointestinal neoplasms. World J Gastroenterol. 2008;14:2962–7.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Fujishiro M, Yahagi N, Kakushima N, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol. 2006;4:688–94.

    Article  PubMed  Google Scholar 

  4. Fujishiro M, Kodashima S, Goto O, et al. Endoscopic submucosal dissection for esophageal squamous cell neoplasms. Dig Endosc. 2009;21:109–15.

    Article  PubMed  Google Scholar 

  5. Repici A, Hassan C, Carlino A, et al. Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc. 2010;71:715–21.

    Article  PubMed  Google Scholar 

  6. Takahashi H, Arimura Y, Masao H, et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc. 2010;72:255–64.

    Article  PubMed  Google Scholar 

  7. Ono S, Fujishiro M, Niimi K, et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy. 2009;41:661–5.

    Article  CAS  PubMed  Google Scholar 

  8. Tachimori Y, Ozawa S, Fujishiro M, et al. Comprehensive registry of esophageal cancer in Japan, 2006. Esophagus. 2014;11:21–47.

    Article  Google Scholar 

  9. Talley NJ, Vakil N. Guidelines for the management of dyspepsia. Am J Gastroenterol. 2005;100:2324–37.

    Article  PubMed  Google Scholar 

  10. van Pinxteren B, Numans ME, et al. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev 2006;3:CD002095.

  11. Jones RH, Baxter G. Lansoprazole 30 mg daily versus ranitidine 150 mg b.d. in the treatment of acid-related dyspepsia in general practice. Aliment Pharmacol Ther. 1997;11:541–6.

    Article  CAS  PubMed  Google Scholar 

  12. Kusano M, Shimoyama Y, Kawamura O, et al. Proton pump inhibitors improve acid-related dyspepsia in gastroesophageal reflux disease patients. Dig Dis Sci. 2007;52:1673–7.

    Article  PubMed  Google Scholar 

  13. Kakushima N, Yahagi N, Fujishiro M, et al. The healing of gastric artificial ulcers after endoscopic submucosal dissection. Dig Endosc. 2004;16:327–31.

    Article  Google Scholar 

  14. Uedo N, Takeuchi Y, Yamada T, et al. Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol. 2007;102:1610–6.

    Article  CAS  PubMed  Google Scholar 

  15. Boo GB, Oh JC, Lee BJ, et al. The effect of proton pump inhibitor on healing of post-esophageal variceal ligation ulcers. Korean J Gastroenterol. 2008;41:232–40.

    Google Scholar 

  16. Kusano M, Shimoyama Y, Sugimoto S, et al. Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol. 2004;39:888–91.

    Article  PubMed  Google Scholar 

  17. Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of oesophagits: a progress report on observer agreement. Gastroenterology. 1996;111:85–92.

    Article  CAS  PubMed  Google Scholar 

  18. Oridate N, Takeda H, Mesuda Y, et al. Evaluation of upper abdominal symptoms using the frequency scale for the symptoms of gastroesophageal reflux disease in patients with laryngopharyngeal reflux symptoms. J Gastroenterol. 2008;43:519–23.

    Article  PubMed  Google Scholar 

  19. Bengtsson M, Ohlsson B, Ulander K. Development and psychometric testing of the visual analogue scale for irritable bowel syndrome (VAS-IBS). BMC Gastroenterol. 2007;7:16.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Chang FY, Lu CL, Chen CY, et al. Efficacy of dioctahedral smectite in treating patients of diarrhea-predominant irritable bowel syndrome. J Gastroenterol Hepatol. 2007;22:2266–72.

    Article  CAS  PubMed  Google Scholar 

  21. Watanabe H, Watanabe N, Ogura R, et al. A randomized prospective trial comparing unsedated endoscopy via transnasal and transoral routes using 5.5 mm video endoscopy. Dig Dis Sci. 2009;54:2155–60.

    Article  PubMed  Google Scholar 

  22. National Cancer Institute. Common Terminology Criteria for Adverse Events, version 3.0. Rockville: National Cancer Institute; 2006.

  23. Bu BD, Linghy EQ, Li HK, et al. Influence of endoscopic submucosal dissection on esophageal motility. World J Gastroenterol. 2013;19:4781–5.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Inoue H, Takeshita K, Nagahama T, et al. Endoscopic mucosal resection of early esophageal cancer: EMRT and EMRC techniques. Stomach Intestine. 1993;28:161–9. In Japanese with English abstract.

    Google Scholar 

  25. Honda M, Nakamura T, Hori Y, et al. Process of healing of mucosal defects in the esophagus after endoscopic mucosal resection: histological evaluation in a dog model. Endoscopy. 2010;42:1092–5.

    Article  CAS  PubMed  Google Scholar 

  26. Ota M, Ohki T, Nakamura T, et al. Investigation of ulcer healing after esophageal EMR/ESD. Esophagus. 2010;7:101–4.

    Article  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 4118777, Japan

    N. Kakushima & H. Ono

  2. Kyoto University Graduate School of Medicine, Kyoto, Japan

    K. Hori, T. Horimatsu, M. Niimi & M. Muto

  3. Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    N. Uedo

  4. NTT Medical Center Tokyo, Tokyo, Japan

    K. Ohata

  5. Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan

    H. Doyama

  6. National Cancer Center East, Chiba, Japan

    K. Kaneko

  7. National Cancer Center, Tokyo, Japan

    I. Oda

  8. Fukushima Medical University, Fukushima, Japan

    T. Hikichi

  9. Okayama University Hospital, Okayama, Japan

    Y. Kawahara

  10. The University of Tokyo Graduate School of Medicine, Tokyo, Japan

    K. Niimi

  11. Fukuoka University Chikushi Hospital, Fukuoka, Japan

    Y. Takaki

  12. Hiroshima City Hospital, Hiroshima, Japan

    M. Mizuno

  13. Kitano General Hospital, Osaka, Japan

    S. Yazumi

  14. Toyama University Hospital, Toyama, Japan

    A. Hosokawa

  15. Mitoyo General Hospital, Kanonji, Kagawa, Japan

    A. Imagawa

  16. Kobe University School of Medicine, Kobe, Japan

    K. Yoshimura

Authors
  1. N. Kakushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Horimatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Uedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Ohata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Doyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. Kaneko
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. I. Oda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. T. Hikichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Y. Kawahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. K. Niimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Y. Takaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. M. Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. S. Yazumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. A. Hosokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. A. Imagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. M. Niimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. K. Yoshimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. M. Muto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Kakushima.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kakushima, N., Hori, K., Ono, H. et al. Proton pump inhibitor after endoscopic resection for esophageal squamous cell cancer: multicenter prospective randomized controlled trial. J Gastroenterol 51, 104–111 (2016). https://doi.org/10.1007/s00535-015-1085-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-015-1085-9

Keywords

Search

Navigation