A prospective randomized trial of either famotidine or pantoprazole for the prevention of bleeding after endoscopic submucosal dissection.
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.
Jeong
Hye Kyong
HK
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Park
Chang Hwan
CH
Jun
Chung Hwan
CH
Lee
Gi Hoon
GH
Kim
Hyung Il
HI
Kim
Hyun Soo
HS
Choi
Sung Kyu
SK
Rew
Jong Sun
JS
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*
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D015738:Famotidine; D000077402:Pantoprazole