title: Safer endoscopic gastric mucosal resection: preoperative proton pump inhibitor administration.
abstract: 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.
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan. ponponta@marianna-u.ac.jp
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kato
authors.forename: Tadateru
authors.initials: T
authors.lastname: Maehata
authors.forename: Masaru
authors.initials: M
authors.lastname: Okamoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsuda
authors.forename: Santa
authors.initials: S
authors.lastname: Hattori
authors.forename: Shunichi
authors.initials: S
authors.lastname: Yamauchi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fujita
authors.forename: Satoshi
authors.initials: S
authors.lastname: Baba
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakaya
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Inaba
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kitajima
authors.forename: Michihiro
authors.initials: M
authors.lastname: Suzuki
authors.forename: Hirohumi
authors.initials: H
authors.lastname: Niwa
authors.forename: Fumio
authors.initials: F
authors.lastname: Itoh
mesh_terms: 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
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors