Safer endoscopic gastric mucosal resection: preoperative proton pump inhibitor administration.
OBJECTIVE
Control of bleeding is crucial in improving the safety of endoscopic mucosal resection (EMR), and intragastric acidity has a great impact on hemostasis and blood coagulation. Proton pump inhibitors (PPI) are potent suppressors of gastric acid; however, PPI need to be continuously administered orally for several days, and thus initial effects may be insufficient if PPI is only administered immediately after EMR. The aim of this study was to determine whether preoperative administration of PPI prior to EMR can elevate intragastric acidity, facilitate better control of intraoperative bleeding (complete coagulation and hemostasis), prevent postoperative bleeding, and facilitate healing of artificial ulcers.


METHODS
A randomized clinical study was conducted in which EMR was performed with or without 1 week of preoperative PPI administration.


RESULTS
Artificial ulcers created by EMR healed more rapidly in patients who received preoperative PPI.


CONCLUSIONS
The results of the study suggest that preoperative administration of PPI before EMR is useful for controlling and preventing bleeding, and for facilitating the healing of artificial ulcers.
Watanabe
Yoshiyuki
Y
Department of Gastroenterology and Hepatology, Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan. ponponta@marianna-u.ac.jp
Kato
Naoyuki
N
Maehata
Tadateru
T
Okamoto
Masaru
M
Tsuda
Takashi
T
Hattori
Santa
S
Yamauchi
Shunichi
S
Fujita
Kazuhiko
K
Baba
Satoshi
S
Nakaya
Shinichi
S
Inaba
Hiroyuki
H
Kitajima
Satoshi
S
Suzuki
Michihiro
M
Niwa
Hirohumi
H
Itoh
Fumio
F
D000236:Adenoma / Q000601:surgery*; D000284:Administration, Oral; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001944:Breath Tests; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects / Q000601:surgery*; D005773:Gastroscopy; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011300:Preoperative Care; D054328:Proton Pump Inhibitors; D013274:Stomach Neoplasms / Q000601:surgery*; D013276:Stomach Ulcer / Q000188:drug therapy; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors