Vonoprazan versus proton pump inhibitors for the management of gastric endoscopic submucosal dissection-induced artificial ulcer: A systematic review with meta-analysis

Abstract

Background: Vonoprazan, a novel potassium-competitive acid blocking agent, has been used in the management of endoscopic submucosal dissection (ESD)-induced artificial ulcers. This study aimed to perform a systematic review and meta-analysis for the comparison of the effects of vonoprazan and proton pump inhibitors (PPIs) in treating ESD-induced artificial ulcers and preventing delayed bleeding in randomized controlled trial and cohort studies.

Methods: We searched OVID-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and clinical trial registries in April 2018 to identify all studies that assess and compare the effects of vonoprazan and PPI in treating ESD-induced artificial ulcers and preventing delayed bleeding. Primary outcome of ulcer healing rate and secondary outcomes of shrinkage rate, ulcer size, and delayed bleeding were studied.

Results: A total of 1265 patients from 12 studies were included in the final analysis. Healing rate at 4 weeks post-ESD was significantly higher in the vonoprazan group than in the PPI group (relative ratio [RR] 1.20 [1.03-1.40]). However, healing rate at 8 weeks post-ESD was significantly higher in the PPI group than in the vonoprazan group (RR 0.68 [0.48-0.97]).There was no evidence of significant difference between groups in shrinkage rate at 4 weeks post-ESD, shrinkage rate at 8 weeks post-ESD, delayed bleeding, ulcer size at 0 weeks post-ESD, and ulcer size at 8 weeks post-ESD.

Conclusions: There was no substantial difference in ulcer healing and post-ESD bleeding between vonoprazan and PPIs. However, vonoprazan more rapidly and effectively treated artificial ulcers after ESD than did PPIs.

Figure 1

Flow diagram showing the number of abstracts and articles identified and evaluated during the review.

Figure 2

Forest plot of the studies comparing healing rate at 4 weeks post-ESD between vonoprazan-treated and proton pump inhibitor (PPI)-treated groups. The figure depicts individual trials as filled squares with relative sample size and the 95% confidence interval (CI) of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect. CI = confidence intervals, PPI = proton pump inhibitor.

Figure 3

Forest plot of studies comparing healing rate at 8 weeks post-ESD between vonoprazan-treated and PPI-treated groups. The figure depicts individual trials as filled squares with relative sample size and the 95% CI of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect. CI = confidence intervals, PPI = proton pump inhibitor.

Figure 4

Forest plot of studies comparing rate of delayed bleeding between vonoprazan-treated and PPI-treated groups. The figure depicts individual trials as filled squares with relative sample size and the 95% CI of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect. CI = confidence intervals, PPI = proton pump inhibitor.

Figure 5

Funnel plot of studies comparing healing rate at 4 weeks post-ESD between vonoprazan-treated and PPI-treated groups. White circles: comparisons included. White diamond: pooled observed log risk ratio.