David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Kagawa T et al. Aliment Pharmacol Ther 2016 Jul 28.

Preliminary study findings suggest lower risk for postprocedure bleeding with vonoprazan but require validation.

Proton-pump inhibitors (PPIs) are used routinely after endoscopic submucosal dissection (ESD) for early gastric cancer to reduce bleeding and promote healing of ESD-induced gastric ulcers. To compare the effectiveness of vonoprazan, a potassium-competitive acid blocker, and PPIs in this setting, investigators in a single center in Japan administered vonoprazan (20 mg/day) to 75 patients for 5 weeks starting the day before ESD. They compared post-procedure rates of bleeding and ulcer healing with those of a historic cohort of matched controls treated with a PPI (20 mg, twice daily for the first 2 days, then once daily) for 8 weeks starting after ESD. Endoscopic ulcer healing was determined at 5 weeks in the vonoprazan group and at 8 weeks in the PPI group.

Complete ulcer healing at final endoscopy was seen in 66.3% of the PPI group and 18.7% of the vonoprazan group (P<0.001). Post-procedure bleeding in the vonoprazan group was 1.3% and 10% in the PPI group (P=0.01). In multivariate analysis, PPI use and antiplatelet agent use were risk factors for bleeding. All bleeding occurred in the first 10 days after the procedure.

CITATION(S):

Kagawa T et al. Vonoprazan prevents bleeding from endoscopic submucosal dissection-induced gastric ulcers. Aliment Pharmacol Ther 2016 Jul 28; [e-pub].

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