Endoscopy 2009; 41(4): 299-303
DOI: 10.1055/s-0029-1214530
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Effects of preoperative administration of omeprazole on bleeding after endoscopic submucosal dissection: a prospective randomized controlled trial

S.  Ono1 , M.  Kato1 , Y.  Ono2 , M.  Nakagawa2 , S.  Nakagawa2 , Y.  Shimizu1 , M.  Asaka2
  • 1Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
  • 2Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Further Information

Publication History

submitted11 May 2008

accepted after revision9 February 2009

Publication Date:
01 April 2009 (online)

Background and aims: The effectiveness of preoperative administration of proton pump inhibitors (PPIs) for the prevention of bleeding after endoscopic submucosal dissection (ESD) is unclear. Our aim was to evaluate the benefit of starting PPI treatment 1 day before ESD to prevent bleeding after the procedure.

Patients and methods: This was a prospective randomized controlled trial. Data for 155 patients who underwent ESD (preoperative administration group: n = 81; postoperative administration group: n = 74) were analyzed. All patients received standard ESD using an insulation-tipped knife. Patients in the preoperative group were administered omeprazole from the day before ESD, and patients in the postoperative group received omeprazole after ESD. Follow-up endoscopy was performed on day 1, day 7, and day 28. Intragastric pH was measured from samples of gastric juice. The primary endpoint of this study was major bleeding related to ESD, and the secondary endpoint was minor bleeding.

Results: Major bleeding occurred in one patient from the postoperative group who had hematemesis. Minor bleeding occurred on day 1 in six patients from the preoperative group and five patients from the postoperative group (7.7 % vs. 7.4 %). There was no significant difference between major and minor bleeding ratios in the two groups. Intragastric pH at ESD in the postoperative group was lower than that in the preoperative group (P < 0.05).

Conclusions: Preoperative administration of omeprazole offers no additional benefit over postoperative administration alone in the prevention of bleeding after ESD among elderly Japanese people.

References

  • 1 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 225-229
  • 2 Oda I, Saito D, Tada M. et al . A multicenter retrospective study of endoscopic resection for early gastric cancer.  Gastric Cancer. 2006;  9 262-270
  • 3 Oka S, Tanaka S, Kaneko I. et al . Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer.  Gastrointest Endosc. 2006;  64 877-883
  • 4 Satoh K, Yamamoto H, Kawata H. et al . Comparison of hemostatic effects by route of H2 receptor antagonist administration following endoscopic mucosal resection in patients with neoplastic gastric lesions.  Aliment Pharmacol Ther. 2005;  21 Suppl 2 105-110
  • 5 Uedo N, Takeuchi Y, Yamada T. et al . Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial.  Am J Gastroenterol. 2007;  102 1610-1616
  • 6 Watanabe Y, Kato N, Maehata T. et al . Safer endoscopic gastric mucosal resection: preoperative proton pump inhibitor administration.  J Gastroenterol Hepatol. 2006;  21 1675-1680
  • 7 Yamaguchi Y, Katsumi N, Tauchi M. et al . A prospective randomized trial of either famotidine or omeprazole for the prevention of bleeding after endoscopic mucosal resection and the healing of endoscopic mucosal resection-induced ulceration.  Aliment Pharmacol Ther. 2005;  21 Suppl 2 111-115
  • 8 Ye B, Cheon J, Choi K. et al . Omeprazole may be superior to famotidine in the management of iatrogenic ulcer after endoscopic mucosal resection: a prospective randomized controlled trial.  Aliment Pharmacol Ther. 2006;  24 837-843
  • 9 Tsuji N, Ishiguro S, Suzuki N. et al . Risk factors for lymph node metastasis of intramucosal gastric cancer: a case-control study [in Japanese with English abstract].  Gastroenterol Endosc. 1999;  41 1059-1065
  • 10 Gotoda T, Yanagisawa A, Sasako M. et al . Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.  Gastric Cancer. 2000;  3 219-225
  • 11 Heldwein W, Schreiner J, Pedrazzoli J. et al . Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers?.  Endoscopy. 1989;  21 258-262
  • 12 Pearson J P, Ward R, Allen A. et al . Mucus degradation by pepsin: comparison of mucolytic activity of human pepsin 1 and pepsin 3: implications in peptic ulceration.  Gut. 1986;  27 243-248
  • 13 Green F W. Effect of acid and pepsin on blood coagulation and platelet aggregation.  Gastroenterology. 1978;  74 38-43
  • 14 Li Y, Sha W, Nie Y. et al . Effect of intragastric pH on control of peptic ulcer bleeding.  J Gastroenterol Hepatol. 2000;  15 148-154
  • 15 Kakushima N, Fujishiro M, Kodashima S. et al . Histopathologic characteristics of gastric ulcers created by endoscopic submucosal dissection.  Endoscopy. 2006;  38 412-415
  • 16 Asaka M, Kimura T, Kudo M. et al . Relationship of Helicobacter pylori to serum pepsinogens in an asymptomatic. Japanese population.  Gastroenterology. 1992;  102 760-766
  • 17 Kato M, Asaka M, Shimizu Y. et al . Relationship between Helicobacter pylori infection and the prevalence, site and histological type of gastric cancer.  Aliment Pharmacol Ther. 2004;  20 Suppl 1 85-89
  • 18 Uemura N, Okamoto S, Yamamoto S. et al . Helicobacter pylori infection and the development of gastric cancer.  N Engl J Med. 2001;  345 784-789

M. KatoMD 

Division of Endoscopy
Hokkaido University Hospital

Nishi-5
Kita-14
Kita-ku
Sapporo
Hokkaido 060-8638
Japan

Fax: +81-11-7067867

Email: m-kato@med.hokudai.ac.jp