Comparison of efficacy of pharmacological therapies for gastric endoscopic submucosal dissection-induced ulcers: a systematic review and network meta-analysis

ABSTRACT

Objectives: This study aimed to compare the efficacy of various anti-ulcer medications in preventing delayed bleeding and promoting ulcer healing after ESD.

Methods: Asystematic search was conducted for articles up to August2019. The treatments of iatrogenic ulcer were analyzed by Bayesian network meta-analysis.

Results: The analysis included 28 studies. Six treatments were compared. For the prevention of delayed bleeding, potassium-competitive acid blocker (P-CAB) alone was superior to proton-pump inhibitor (PPI) alone [RR = 1.02, 95%CI (1.00, 1.05)]. Treatments based on P-CAB tended to be better than the non-P-CAB groups [RR = 1.05, 95%CI (1.03, 1.07)]. Concerning the ulcer healing rate at 4 weeks, the combined treatment of PPI and mucoprotective agent (MP) was superior to PPI alone [RR = 1.81, 95%CI (1.19, 2.76)] and P-CAB alone [RR = 2.75, 95%CI (1.02, 7.44)]. At 8 weeks, PPI+MP and P-CAB+MP tend to be superior to than the other four groups. The healing effect of MP-based therapies was better than that of non-MP groups at 4 weeks [RR = 1.63, 95%CI (1.32, 2.01)] and 8 weeks [RR = 1.06, 95%CI (1.02, 1.11)].

Conclusion: P-CAB may prevent delayed bleeding, but not significantly. MP agents have the potential to heal post-ESD ulcers.

KEYWORDS:

• Anti-ulcer medication
• endoscopic submucosal dissection
• network meta-analysis
• proton-pump inhibitor
• potassium-competitive acid blocker

Article highlights

• Potassium competitive acid blocker is anew generation of acid inhibitors developed in recent years.

• This meta-analysis investigated the efficacy of various anti-ulcer medications in preventing delayed bleeding and promoting ulcer healing after endoscopic submucosal dissection.

• P-CAB may reduce bleeding risk to alimited extent.

• Mucoprotective agents have the potential to promote ulcer healing after endoscopic submucosal dissection.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with afinancial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as awhole, and have given their approval for this version to be published.

Author’s contributions statement

Gao HQ is involved in literature search, quality assessment, data extraction and data analysis, manuscript drafting and editing. Jing JY is involved in the conception and design, research identification and selection, data extraction, data analysis and interpretation, manuscript drafting and editing. Pan WS is involved in the conception and design, data analysis and interpretation, manuscript drafting and editing. Li LN is involved in research identification and selection, data extraction and quality assessment, manuscript drafting and editing. Zhang CJ is involved in the design and discussion of the study, manuscript drafting and editing. Tu JF, Geng XG, Wang JY, and Zhou XL are involved in manuscript drafting and editing. All authors have approved the final version of this manuscript. All authors agree to be accountable for all aspects of the work.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was supported by Zhejiang medicine key scientific and technology project [grant number: 2018258924]; Zhejiang medicine scientific and technology project [grant number: 2019RC094]; and Basic Public Welfare Research Project of Zhejiang Province [grant number: LGF20F020018].