title: A prospective randomized trial of either famotidine or pantoprazole for the prevention of bleeding after endoscopic submucosal dissection.
abstract: Endoscopic submucosal dissection (ESD) has been reported to have a higher bleeding rate than conventional methods. However, there are few reports on whether a proton pump inhibitor or a histamine2-receptor antagonist is the more effective treatment for preventing bleeding after ESD. In a prospective trial, patients undergoing ESD due to gastric adenoma or adenocarcinoma were randomly assigned to pantoprazole or famotidine. Both drugs were given intravenously for the first 2 days, thereafter by mouth. Eighty-five in the pantoprazole group and 79 in the famotidine group were included for analysis. Primary outcome measure was the delayed bleeding rate. Clinical characteristics were not different between the two groups. The delayed bleeding rate was significantly lower in the pantoprazole group compared with the famotidine group (3.5% vs. 12.7%, p=0.031). On multivariate analysis, the preventive use of pantoprazole (relative hazard: 0.220, 95% CI: 0.051- 0.827, p=0.026) and the specimen size (> or =34 mm, relative hazard: 4.178, 95% CI: 1.229-14.197, p=0.022) were two independent factors predictive of delayed bleeding. There were no significant differences in en bloc and complete resection rate between the two groups. In conclusion, pantoprazole is more effective than famotidine for the prevention of delayed bleeding after ESD.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hye Kyong
authors.initials: HK
authors.lastname: Jeong
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Park
authors.forename: Chung Hwan
authors.initials: CH
authors.lastname: Jun
authors.forename: Gi Hoon
authors.initials: GH
authors.lastname: Lee
authors.forename: Hyung Il
authors.initials: HI
authors.lastname: Kim
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Choi
authors.forename: Jong Sun
authors.initials: JS
authors.lastname: Rew
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004210:Dissection; D015738:Famotidine / Q000627:therapeutic use*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D016037:Single-Blind Method; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D015738:Famotidine; D000077402:Pantoprazole