Jaruvongvanich Veeravich, Poonsombudlert Kittika, Ungprasert Patompong
Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii, USA.
Department of Medicine, King Chulalongkorn Memorial Hospital.
Eur J Gastroenterol Hepatol. 2018 Dec;30(12):1416-1421. doi: 10.1097/MEG.0000000000001204.
Acid secretion inhibitors are usually prescribed to promote the healing of artificial ulcers caused by endoscopic submucosal dissection (ESD) to reduce the risk of gastric perforation and delayed bleeding. Vonoprazan is a newer agent that has been shown to be more potent than a proton-pump inhibitor (PPI). However, it remains unclear whether vonoprazan is more effective than PPI in promoting healing of ulcers caused by ESD. Medline and Embase databases were searched through January 2018 for studies that compared the rate of complete healing of ulcers caused by ESD and post-ESD delayed bleeding in patients who received vonoprazan versus those who received PPI after ESD. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect model, generic inverse variance method. The between-study heterogeneity was quantified using the Q-statistic and I. A total of six studies consisting of 461 patients were identified. The likelihood that ulcers caused by ESD were completely healed at 4-8 weeks after the procedure was significantly higher among patients who received vonoprazan compared with those who received PPI, with a pooled OR of 2.27 (95% CI=1.38-3.73; I=0%). The risk of developing post-ESD delayed bleeding was also numerically lower among those who received vonoprazan, with a pooled OR of 0.79, although the result did not reach statistical significance (95% CI=0.18-3.49; I=29%). This study found that patients who received vonoprazan after ESD had a significantly higher rate of completely healed ulcers compared with those who received PPI.
通常会开具酸分泌抑制剂来促进内镜黏膜下剥离术（ESD）所致人工溃疡的愈合，以降低胃穿孔和延迟出血的风险。沃克奥美拉唑是一种新型药物，已被证明比质子泵抑制剂（PPI）更有效。然而，沃克奥美拉唑在促进ESD所致溃疡愈合方面是否比PPI更有效仍不清楚。检索了截至2018年1月的Medline和Embase数据库，以查找比较接受沃克奥美拉唑与接受ESD后PPI的患者中ESD所致溃疡的完全愈合率和ESD后延迟出血情况的研究。使用随机效应模型、通用逆方差法计算合并比值比（OR）和95%置信区间（CI）。使用Q统计量和I统计量对研究间的异质性进行量化。共确定了6项研究，涉及461例患者。与接受PPI的患者相比，接受沃克奥美拉唑的患者在术后4 - 8周ESD所致溃疡完全愈合的可能性显著更高，合并OR为2.27（95%CI = 1.38 - 3.73；I = 0%）。接受沃克奥美拉唑的患者发生ESD后延迟出血的风险在数值上也较低，合并OR为0.79，尽管结果未达到统计学显著性（95%CI = 0.18 - 3.49；I = 29%）。本研究发现，与接受PPI的患者相比，ESD后接受沃克奥美拉唑的患者溃疡完全愈合率显著更高。
