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Review
. 2015 Mar;56(2):85-90.
doi: 10.3164/jcbn.14-101. Epub 2014 Dec 27.

Proton pump inhibitor alone vs proton pump inhibitor plus mucosal protective agents for endoscopic submucosal dissection-induced ulcer: a systematic review and meta-analysis

Toshihiro Nishizawa  1 , Hidekazu Suzuki  2 , Takanori Kanai  2 , Naohisa Yahagi  3
Affiliations
Review

Proton pump inhibitor alone vs proton pump inhibitor plus mucosal protective agents for endoscopic submucosal dissection-induced ulcer: a systematic review and meta-analysis

Toshihiro Nishizawa et al. J Clin Biochem Nutr. 2015 Mar.

Abstract

Mucosal protective agents may improve healing of patients with endoscopic submucosal dissection-induced ulcers. The present study systematically evaluated published clinical trials to determine whether combined therapeutic use of mucosal protective agents and proton pump inhibitors can improve the outcome of patients with endoscopic submucosal dissection-induced ulcers compared to treatment with proton pump inhibitors alone. PubMed, the Cochrane Library, and the Igaku-Chuo-Zasshi database were searched to identify eligible randomized trials for systematic review. We identified 11 randomized trials for inclusion in our study (1,160 patients). Pooled endoscopic submucosal dissection-induced ulcer healing rates were 45.8% and 34.4% for patients with or without mucosal protective agents, respectively. The odds ratio was 2.28 (95% confidence interval, 1.57-3.31) with no significant study heterogeneity. In conclusion, the systematic review and meta-analysis showed that the combined therapeutic use of proton pump inhibitors and mucosal protective agents improved healing rates of endoscopic submucosal dissection-induced ulcers compared to treatment with proton pump inhibitor monotherapy.

Keywords: endoscopic submucosal dissection; mucosal protective agents; rebamipide; ulcer.

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Figures

Fig. 1
Fig. 1
Flow chart for selecting RCTs for inclusion in the systematic review.
Fig. 2
Fig. 2
Odds ratio meta-analysis plot comparing ESD-induced ulcer healing rates for patients receiving treatment with PPIs plus mucosal protective agents versus those receiving PPI monotherapy.
Fig. 3
Fig. 3
Odds ratio meta-analysis plot comparing ESD-induced ulcer healing rates in patients treated for 4 weeks with PPIs plus mucosal protective agents versus those receiving PPI monotherapy.
Fig. 4
Fig. 4
Odds ratio meta-analysis plot comparing ESD-induced ulcer healing rates in patients treated for 8 weeks with PPIs plus mucosal protective agents versus those receiving PPI monotherapy.
Fig. 5
Fig. 5
Odds ratio meta-analysis plot comparing ESD-induced ulcer healing rates in patients treated with PPIs plus mucosal protective agents versus those receiving PPI monotherapy excluding reports from three conference abstracts.
Fig. 6
Fig. 6
Funnel plot of the included studies for ESD-induced ulcer healing rates.
See this image and copyright information in PMC

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