Optimal Duration of Proton Pump Inhibitor in the Treatment of Endoscopic Submucosal Dissection-Induced Ulcers: A Retrospective Analysis and Prospective Validation Study
Optimal Duration of Proton Pump Inhibitor in the Treatment of Endoscopic Submucosal Dissection-Induced Ulcers: A Retrospective Analysis and Prospective Validation Study
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DOI：
10.1007/s10620-011-1941-2
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发表时间：
2012-02-01
影响因子：
3.1
通讯作者：
Kim, Sun-Joo
中科院分区：
文献类型：
--
作者：
Lee, Suck-Ho;Lee, Chang Kyun;Kim, Sun-Joo
质子泵抑制剂（PPI）治疗内镜粘膜下剥离术（ESD）引起的胃溃疡的最佳持续时间尚未明确。本研究的目的是确定PPI治疗ESD引起的胃溃疡的最佳持续时间。本回顾性分析和前瞻性随机验证共纳入了333名接受ESD的患者。我们对 ESD 数据库中 221 名患者的医疗记录和内窥镜图像进行了回顾性审查。根据回顾性分析的结果，112 例 ESD 引起的溃疡超过 40 mm 的患者被随机分为两组（兰索拉唑 30 mg 4 周或 8 周疗程）。主要结果测量是评估 ESD 后溃疡的愈合相关因素（回顾性分析），并根据 PPI 治疗持续时间比较大型（千分之一 40 毫米）ESD 诱发溃疡的完全粘膜愈合率（前瞻性验证）。回顾性分析的多变量逻辑回归显示，PPI 治疗持续时间 < 8 周和 ESD 后溃疡 千分之一的40毫米尺寸与不完全愈合有关。在一项前瞻性验证中，对于 ESD 引起的大溃疡（千分之一 40 mm），8 周随访时，8 周 PPI 组的完全愈合率显着高于 4 周 PPI 组（83.3% vs. 42.6%，P < 0.01）。 PPI 治疗的最佳持续时间根据初始溃疡大小而变化。 ESD 引起的溃疡超过 40 毫米的患者应接受为期 8 周的 PPI 疗程。
The optimal duration of proton pump inhibitor (PPI) use in the treatment of endoscopic submucosal dissection (ESD)-induced ulcers has not been well defined.The aim of study was to determine the optimal duration of PPI treatment for ESD-induced gastric ulcers.A total of 333 patients who underwent ESD were included in this retrospective analysis and prospective randomized validation. Medical records and endoscopic images for the 221 patients in our ESD-database were reviewed retrospectively. Based on the results of the retrospective analysis, 112 patients with ESD-induced ulcers over 40 mm were randomly assigned to two groups (4- or 8-week course of Lansoprazole 30 mg). Main outcome measurements were to assess the healing-related factors of post-ESD ulcers (retrospective analysis) and to compare complete mucosal healing rate in large (a parts per thousand yen40 mm) ESD-induced ulcers according to the duration of PPI treatment (prospective validation).Multivariate logistic regression from a retrospective analysis showed that a duration of PPI treatment < 8 weeks and a post-ESD ulcer a parts per thousand yen40 mm in size were associated with incomplete healing. In a prospective validation, the rate of complete healing in the 8-week PPI group was significantly higher than that of the 4-week PPI group for a large (a parts per thousand yen40 mm) ESD-induced ulcer at 8 weeks follow-up (83.3 vs. 42.6%, P < 0.01).The optimal duration of PPI treatment varies based on the initial ulcer size. Patients with an ESD-induced ulcer over 40 mm should be treated with an 8-week course of PPIs.