title: Effects of preoperative proton pump inhibitor administration on bleeding after gastric endoscopic submucosal dissection: A systematic review and meta-analysis.
abstract: OBJECTIVE
  The efficacy of using proton pump inhibitors (PPIs) prior to gastric endoscopic submucosal dissection (ESD) to reduce gastric bleeding remains controversial. This study aimed to systematically review the literature to evaluate the efficacy of preoperative PPI use to reduce post-ESD bleeding.
  
  
  METHODS
  PubMed, the Cochrane library, and the Igaku-Chuo-Zasshi database were searched to identify randomized trials eligible for inclusion in the systematic review. Data from four studies (406 patients) were combined to calculate a pooled risk difference (RD) for developing post-ESD bleeding.
  
  
  RESULTS
  Compared with patients who received no premedication, the pooled RD for post-ESD bleeding in patients who received preoperavive PPI was -0.027 (95% confidence interval: -0.070-0.017, p = 0.228), without significant heterogeneity. Preoperavive PPI use significantly increased gastric pH (weighted mean difference: 1.289, 95% CI: 0.227-2.352, p = 0.0174).
  
  
  CONCLUSIONS
  This systematic review and meta-analysis showed that premedication with PPI had no advantage for the prevention of post-ESD bleeding, despite increasing gastric pH.
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School Of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nishizawa
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School Of Medicine, Tokyo, Japan; Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Akimoto
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School Of Medicine, Tokyo, Japan.
authors.forename: Tadateru
authors.initials: T
authors.lastname: Maehata
authors.affiliation: Japan Council for Quality Health Care, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Morizane
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School Of Medicine, Tokyo, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
keywords: Proton pump inhibitor; gastric bleeding; gastric endoscopic submucosal dissection; premedication; systematic review