Vonoprazan is superior to proton pump inhibitors in healing artificial ulcers of the stomach post‐endoscopic submucosal dissection: A propensity score‐matching analysis

• Published in: Digestive endoscopy 2017-01, Vol.29 (1), p.57-64
• Main Authors: Maruoka, Daisuke, Arai, Makoto, Kasamatsu, Shingo, Ishigami, Hideaki, Taida, Takashi, Okimoto, Kenichiro, Saito, Keiko, Matsumura, Tomoaki, Nakagawa, Tomoo, Katsuno, Tatsuro, Yokosuka, Osamu
• Format: Article
• Language: English
• Subjects: Aged; artificial ulcer; Endoscopic Mucosal Resection - adverse effects; endoscopic submucosal dissection; Esomeprazole - therapeutic use; Female; Follow-Up Studies; gastric carcinoma; Gastroscopy; Humans; Male; Postoperative Complications - diagnosis; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Propensity Score; Prospective Studies; proton pump inhibitor; Proton Pump Inhibitors - therapeutic use; Pyrroles - therapeutic use; Stomach Neoplasms - surgery; Stomach Ulcer - diagnosis; Stomach Ulcer - drug therapy; Stomach Ulcer - etiology; Sulfonamides - therapeutic use; Treatment Outcome; vonoprazan
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/den.12705

Background and Aim Proton pump inhibitors (PPI) are effective at healing artificial ulcers after endoscopic submucosal dissection (ESD) for gastric neoplasms; however, the efficacy of vonoprazan is not completely understood. The aim of the present study was to determine the healing effect of vonoprazan on artificial ulcers post‐gastric ESD relative to PPI. Methods Thirty‐five patients who underwent gastric ESD between April and November 2015 were treated with vonoprazan 20 mg/day for 4 weeks and subsequently underwent endoscopy for evaluation of ulcer size (V group). Ulcer contraction rate was determined by the following formula: ([ESD specimen size] – [ulcer size at 4 weeks after ESD])/(ESD specimen size) × 100%. We compared the results with those of a historical control group treated with esomeprazole 20 mg/day for 4 weeks after gastric ESD and subsequently measured their ulcer size (33 patients, E group) by propensity score‐matching methods. Results Sixty‐two subjects were enrolled after propensity score‐matching. Ulcer contraction rate at 4 weeks after ESD in the V group was significantly higher than that of the E group (97.7 ± 3.2% vs 94.5 ± 6.7%, respectively, P = 0.025). Number of subjects with a scar‐stage ulcer (100% contraction rate) tended to be higher in the V group relative to the E group (32% [10 of 31] vs 13% [4 of 31], respectively, P = 0.070, McNemar's chi‐squared test). Conclusion Vonoprazan has a faster post‐gastric ESD artificial ulcer contraction rate than esomeprazole. Vonoprazan may supersede PPI in treating post‐ESD artificial ulcers of the stomach.