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.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
United European Gastroenterol J. 2016 Feb;4(1):5-10. doi: 10.1177/2050640615588023. Epub 2015 Jun 9.
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.
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.
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).
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.
质子泵抑制剂（PPIs）在胃内镜黏膜下剥离术（ESD）前使用以减少胃出血的疗效仍存在争议。本研究旨在系统地回顾文献，以评估术前使用 PPI 减少 ESD 后出血的疗效。
检索 PubMed、Cochrane 图书馆和 Igaku-Chuo-Zasshi 数据库，以确定符合纳入系统评价的随机试验。将四项研究（406 例患者）的数据合并，计算发生 ESD 后出血的合并风险差（RD）。
与未接受预处理的患者相比，接受术前 PPI 治疗的患者 ESD 后出血的合并 RD 为-0.027（95%置信区间：-0.070-0.017，p=0.228），无显著异质性。术前 PPI 应用显著增加胃 pH 值（加权均数差：1.289，95%置信区间：0.227-2.352，p=0.0174）。
本系统评价和荟萃分析表明，尽管增加了胃 pH 值，但 PPI 预处理对预防 ESD 后出血没有优势。
