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High Dose Proton Pump Inhibitor Infusion Versus Bolus Injection for the Prevention of Bleeding After Endoscopic Submucosal Dissection: Prospective Randomized Controlled Study

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Abstract

Background

A high dose of continuous intravenous infusion of proton pump inhibitor (PPI) is the standard treatment for peptic ulcer bleeding. The optimal dose for the prevention of bleeding after endoscopic submucosal dissection (ESD) is unclear.

Aim

The purpose of this study was to determine whether stronger acid suppression more effectively prevents bleeding and high risk ulcer stigma (HRS) after gastric ESD.

Methods

A total of 273 patients who underwent ESD were randomly assigned to one of two treatment groups: the continuous infusion group and the bolus injection group. Second-look endoscopy was performed on the following day after ESD. The incidences and risk factors of HRS identified by second-look endoscopy and delayed bleeding were analyzed.

Results

There were no differences in the incidences of HRS and delayed bleeding between two treatment groups. The incidence of HRS was 15.8 % (43/273) and the gross morphology (flat or depressed) was identified as a significant factor associated with HRS. The incidence of delayed bleeding was 8.4 % (23/273) and the gross morphology (flat) and the presence of submucosal invasive cancer were identified as the associated risk factors for delayed bleeding.

Conclusion

The incidences of delayed bleeding and HRS identified by second-look endoscopy were not affected by PPI infusion methods. Flat or depressed morphologic lesions and submucosal invasive cancer should be closely monitored.

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Acknowledgments

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institue (KHIDI), funded by Ministry for Health & Welfare, Republic of Korea (grant number: HI12C1845).

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 626-770, Korea

    Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Joung Boom Hong, Su Bum Park, Su Jin Kim & Mong Cho

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  1. Cheol Woong Choi
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  2. Dae Hwan Kang
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  6. Su Jin Kim
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  7. Mong Cho
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Correspondence to Dae Hwan Kang.

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Choi, C.W., Kang, D.H., Kim, H.W. et al. High Dose Proton Pump Inhibitor Infusion Versus Bolus Injection for the Prevention of Bleeding After Endoscopic Submucosal Dissection: Prospective Randomized Controlled Study. Dig Dis Sci 60, 2088–2096 (2015). https://doi.org/10.1007/s10620-015-3560-9

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  • DOI: https://doi.org/10.1007/s10620-015-3560-9

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