Suto Daisuke, Yoshida Masashi, Otake Takaaki, Ichiishi Eiichiro, Sato Kiichi, Murata Kazumoto, Ebinuma Hirotoshi, Odaira Hironori, Suzuki Yutaka, Kohgo Yutaka
Department of Gastroenterology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Ann Med Surg (Lond). 2020 Oct 7;60:27-30. doi: 10.1016/j.amsu.2020.10.002. eCollection 2020 Dec.
Vonoprazan has been more widely used for artificial ulcers after endoscopic submucosal dissection (ESD) for early gastric cancer; however, no reports have examined intragastric pH during ESD. The present study aimed to measure gastric pH at the time of ESD and the clinical course afterwards for patients treated with vonoprazan the night before undergoing ESD.
We examined medication status regarding gastric acid secretion and antithrombotic drugs, post-ESD bleeding as a perioperative complication, and the timing of upper gastrointestinal endoscopy after ESD and ulcer healing in 156 patients who underwent gastric ESD at our hospital from January 2014 to December 2019. The gastric pH was measured at the time of ESD after administration of 20 mg vonoprazan on the night before gastric ESD.
There were 14 cases of post-ESD bleeding in patients treated with proton-pump inhibitors (PPIs), including oozing during second-look endoscopy compared to only 1 case of bleeding with vonoprazan administration (p < 0.05). Vonoprazan was also associated with better post-ESD ulcer healing than PPIs. Gastric pH during ESD after vonoprazan administration on the night before gastric ESD was ≥6.96 in all 11 patients.
Post-ESD bleeding was reduced, and ulcer healing was improved in patients treated with vonoprazan the night before their procedure. Our results suggest high gastric pH during ESD due to vonoprazan administration may be beneficial for hemostasis and ulcer healing following ESD.
沃克（富马酸伏诺拉生）已更广泛地用于早期胃癌内镜黏膜下剥离术（ESD）后的人工溃疡；然而，尚无关于ESD期间胃内pH值的报告。本研究旨在测量ESD时的胃pH值以及在ESD前一晚接受沃克治疗的患者术后的临床病程。
我们调查了2014年1月至2019年12月在我院接受胃ESD的156例患者的胃酸分泌和抗血栓药物用药情况以及作为围手术期并发症的ESD后出血情况，以及ESD后上消化道内镜检查的时间和溃疡愈合情况。在胃ESD前一晚给予20mg沃克后，于ESD时测量胃pH值。
接受质子泵抑制剂（PPI）治疗的患者中有14例发生ESD后出血，包括二次内镜检查时的渗血，而使用沃克治疗的患者中只有1例出血（p<0.05）。与PPI相比，沃克还与ESD后更好的溃疡愈合相关。在胃ESD前一晚给予沃克后，所有11例患者在ESD期间的胃pH值均≥6.96。
在手术前一晚接受沃克治疗的患者中，ESD后出血减少，溃疡愈合得到改善。我们的结果表明，由于使用沃克导致ESD期间胃内pH值升高可能有利于ESD后的止血和溃疡愈合。
