Role of antisecretory agents for gastric endoscopic submucosal dissection.
Gastric endoscopic submucosal dissection (ESD) causes artificial gastric ulcers and there is no consensus regarding the optimal perioperative management in terms of prevention of intra- or postoperative bleeding and promotion of healing. Traditionally, 8-week administration of proton pump inhibitors (PPI) and mucosal protective agents were used in the same way as for peptic ulcer management. However, recent studies have revealed that prior use of PPI might reduce intraoperative bleeding or early-phase postoperative bleeding, and combination of histamine-2 receptor antagonist (H2RA), and second-look endoscopy might have a similar effect on postoperative bleeding to PPI. Additionally, the advantage of PPI over H2RA is not proven and the optimal duration of PPI may be shortened until 2 weeks when the deteriorating factors for ESD ulcer are excluded. Furthermore, mucosal protective agents may facilitate ulcer healing. Further studies are needed to determine the optimal treatment protocol before and after ESD for both prevention of bleeding complication and promotion of ulcer healing, by using available antisecretory agents and mucosal protective agents.
Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. mtfujish-kkr@umin.ac.jp
Mitsuhiro
M
Fujishiro
Philip W Y
PW
Chiu
Hsui-Po
HP
Wang
D004210:Dissection / Q000379:methods*; D004334:Drug Administration Schedule; D004564:Electrocoagulation; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000098:blood supply / Q000187:drug effects / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007564:Japan; D055806:Microvessels / Q000601:surgery; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011300:Preoperative Care; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012086:Reoperation; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013276:Stomach Ulcer / Q000517:prevention & control*; D013392:Sucralfate / Q000008:administration & dosage; D013525:Surgical Instruments; D014945:Wound Healing / Q000187:drug effects
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D013392:Sucralfate