title: High Dose Proton Pump Inhibitor Infusion Versus Bolus Injection for the Prevention of Bleeding After Endoscopic Submucosal Dissection: Prospective Randomized Controlled Study.
abstract: BACKGROUND
  A high dose of continuous intravenous infusion of proton pump inhibitor (PPI) is the standard treatment for peptic ulcer bleeding. The optimal dose for the prevention of bleeding after endoscopic submucosal dissection (ESD) is unclear.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether stronger acid suppression more effectively prevents bleeding and high risk ulcer stigma (HRS) after gastric ESD.
  
  
  METHODS
  A total of 273 patients who underwent ESD were randomly assigned to one of two treatment groups: the continuous infusion group and the bolus injection group. Second-look endoscopy was performed on the following day after ESD. The incidences and risk factors of HRS identified by second-look endoscopy and delayed bleeding were analyzed.
  
  
  RESULTS
  There were no differences in the incidences of HRS and delayed bleeding between two treatment groups. The incidence of HRS was 15.8 % (43/273) and the gross morphology (flat or depressed) was identified as a significant factor associated with HRS. The incidence of delayed bleeding was 8.4 % (23/273) and the gross morphology (flat) and the presence of submucosal invasive cancer were identified as the associated risk factors for delayed bleeding.
  
  
  CONCLUSIONS
  The incidences of delayed bleeding and HRS identified by second-look endoscopy were not affected by PPI infusion methods. Flat or depressed morphologic lesions and submucosal invasive cancer should be closely monitored.
authors.affiliation: Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 626-770, Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Joung Boom
authors.initials: JB
authors.lastname: Hong
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage* / Q000627:therapeutic use*; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole
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