A matched case-control study of a novel Acid-pump antagonist and proton-pump inhibitor for the treatment of iatrogenic ulcers caused by endoscopic submucosal dissection

Abstract

Background/aims: Revaprazan, a novel acid-pump antagonist, and proton-pump inhibitors (PPIs) have pH-independent effects on ulcer healing. The addition of a PPI promotes the cell restitution rate as well as vessel regeneration and maturation for ulcer repair. Revaprazan is known to protect the mucosa by increasing the prostaglandin concentration.

Methods: We reviewed the medical records of patients who underwent endoscopic submucosal dissection (ESD) for gastric neoplasia at Yeungnam University Hospital between January 2008 and May 2009. We conducted a matched case-control study to compare the healing rates effected by revaprazan and rabeprazole.

Results: Each group consisted of 30 patients. The baseline characteristics did not differ significantly between the two groups. Stage S1 disease was observed in 97% and 100% of patients after 8 weeks of treatment in the revaprazan and rabeprazole groups, respectively. In the revaprazan group, only one patient had stage H2 disease: a 54-year-old man with a 5.5-cm lesion after ESD of the ulcer, type IIa early gastric cancer, and adenocarcinoma. No serious adverse effects occurred during the treatment period in either group.

Conclusions: The safety and efficacy profiles of revaprazan and rabeprazole are similar for the treatment of ESD-induced ulcers.

Keywords: Acid pump antagonists; Endoscopic submucosal dissection; Proton pump inhibitors; Rabeprazole; Revaprazan.

Fig. 1

After initial incision of the mucosa with the needle knife to allow insertion of tip of insulation-tipped diathermic (IT) knife, complete incision is made by IT knife circumferentially. (D) En bloc dissection of the submucosal tissue was performed. (E) EGC was resected completely. (F) Hemostasis was achieved with hemoclips and cauterization.

Fig. 2

A patient with stage H2 disease 8 weeks after endoscopic submucosal dissection (ESD). (A) At the lesser-curvature side of the proximal body, an ulcer of about 5.5 cm with several reddish spots was noted 1 day post-ESD. (B-D) An ulcer of about 0.5 cm that was almost completely covered with regenerating epithelium was noted at 8 weeks post-ESD. (E, F) A red scar with rough epithelialization without mucosal breaks was noted at 5 months post-ESD.