PMID- 29870582 OWN - NLM STAT- MEDLINE DCOM- 20190514 LR - 20190514 IS - 1440-1746 (Electronic) IS - 0815-9319 (Linking) VI - 33 IP - 12 DP - 2018 Dec TI - Role of mucoprotective agents in endoscopic submucosal dissection-derived ulcers: A systematic review. PG - 1948-1955 LID - 10.1111/jgh.14305 [doi] AB - BACKGROUND: Currently, it is still unclear whether adding a mucoprotective agent to a proton pump inhibitor (PPI) results in better outcomes compared with using a PPI alone in patients with post-gastric endoscopic submucosal dissection (ESD) ulcers. This study aimed to examine the efficacy of PPI alone versus combination treatment in healing of post-gastric ESD ulcers, as well as on delayed bleeding and amount of blood transfused. METHODS: A systematic search of MEDLINE, EMBASE, Cochrane, and ISI Web of knowledge databases, up until May 2017, for randomized trials comparing PPI alone versus PPI plus a mucoprotective drug in achieving ulcer healing in patients undergoing gastric ESD was performed. The primary outcome is scarring stage on endoscopic assessment at 4 or 8 weeks after gastric ESD. RESULTS: From an initial 3071 citations, eight articles (n = 953 lesions from 934 patients) were analyzed. Patients receiving combination treatment achieved a scarring stage significantly more often than those on a PPIs alone at 4 or 8 weeks after ESD, (risk ratio = 1.36, 95% CI; 1.06-1.75). No study reported amount of blood transfused. There were no significant between treatment-group differences in terms of delayed bleeding (risk ratio = 0.58, 95% CI; 0.17-1.99). Neither location of ulcer nor Helicobacter pylori infection was related to ulcer scarring stage. CONCLUSION: The limited evidences suggested combination treatment may be more effective in accelerating the process of ulcer healing in patients undergoing gastric ESD than the use of PPI alone, but does not appear to alter delayed bleeding risk. CI - (c) 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. FAU - Pittayanon, Rapat AU - Pittayanon R AUID- ORCID: 0000-0001-6407-5245 AD - Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Canada. AD - Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital the Thai Red Cross, Bangkok, Thailand. FAU - Martel, Myriam AU - Martel M AD - Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Canada. FAU - Barkun, Alan AU - Barkun A AD - Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Canada. LA - eng PT - Journal Article PT - Systematic Review DEP - 20180625 PL - Australia TA - J Gastroenterol Hepatol JT - Journal of gastroenterology and hepatology JID - 8607909 RN - 0 (Demulcents) RN - 0 (Proton Pump Inhibitors) SB - IM MH - Aged MH - Blood Transfusion MH - Demulcents/adverse effects/*therapeutic use MH - Drug Therapy, Combination MH - Endoscopic Mucosal Resection/*adverse effects MH - Female MH - Gastroscopy/*adverse effects MH - Humans MH - Male MH - Middle Aged MH - Peptic Ulcer Hemorrhage/diagnosis/etiology/prevention & control MH - Protective Factors MH - Proton Pump Inhibitors/adverse effects/*therapeutic use MH - Risk Factors MH - Stomach Ulcer/diagnosis/*drug therapy/etiology MH - Time Factors MH - Treatment Outcome MH - Wound Healing/*drug effects OTO - NOTNLM OT - PPI OT - healing OT - mucoprotective agent OT - post-gastric ESD OT - ulcer EDAT- 2018/06/06 06:00 MHDA- 2019/05/15 06:00 CRDT- 2018/06/06 06:00 PHST- 2018/05/10 00:00 [received] PHST- 2018/05/21 00:00 [revised] PHST- 2018/05/27 00:00 [accepted] PHST- 2018/06/06 06:00 [pubmed] PHST- 2019/05/15 06:00 [medline] PHST- 2018/06/06 06:00 [entrez] AID - 10.1111/jgh.14305 [doi] PST - ppublish SO - J Gastroenterol Hepatol. 2018 Dec;33(12):1948-1955. doi: 10.1111/jgh.14305. Epub 2018 Jun 25.