Published online May 16, 2018. doi: 10.4253/wjge.v10.i5.83
Peer-review started: January 31, 2018
First decision: February 27, 2018
Revised: March 4, 2018
Accepted: March 20, 2018
Article in press: March 20, 2018
Published online: May 16, 2018
To investigate factors associated with the healing of endoscopic submucosal dissection (ESD)-induced ulcers.
We enrolled 132 patients with gastric tumors scheduled for ESD. Following ESD, patients were treated with daily lansoprazole 30 mg or vonoprazan 20 mg. Ulcer size was endoscopically measured on the day after ESD and at 4 and 8 wk. The gastric mucosa was endoscopically graded according to the Kyoto gastritis scoring system. We assessed the number of patients with and without a 90% reduction in ulcer area at 4 wk post-ESD and scar formation at 8 wk, and looked for risk factors for slower healing.
The mean size of gastric tumors and post-ESD ulcers was 17.4 ± 12.1 mm and 32.9 ± 13.0 mm. The mean reduction rates in ulcer area were 90.4% ± 0.8% at 4 wk and 99.8% ± 0.1% at 8 wk. The reduction rate was associated with the Kyoto grade of gastric atrophy at 4 wk (A0: 97.9% ± 0.6%, A1: 93.4% ± 4.1%, and A2: 89.7% ± 1.0%, respectively). In multivariate analysis, the factor predicting 90% reduction at 4 wk was gastric atrophy (Odds ratio: 5.678, 95%CI: 1.190-27.085, P = 0.029).
The healing speed of post-ESD ulcers was associated with the degree of gastric mucosal atrophy, and Helicobacter pylori eradication therapy is required to perform at younger age.
Core tip: It is important to investigate factors influencing the healing speed of endoscopic submucosal dissection (ESD)-induced ulcers to prevent gastrointestinal bleeding. Although previous studies have looked at many factors related to ESD-induced ulcer healing, such as location of the tumor, submucosal fibrosis, initial ulcer size, diabetes, and method of gastric acid suppression, this report showed that the severity of gastric atrophy is possible factor to affect speed of ESD-induced ulcer healing. Therefore, Helicobacter pylori (H. pylori) eradication therapy is required to perform at younger age before progression of gastric mucosal atrophy to prevent development of H. pylori-related diseases and bleeding from ESD-induced ulcer.