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Histamine2-Receptor Antagonists, Proton Pump Inhibitors, or Potassium-Competitive Acid Blockers Preventing Delayed Bleeding After Endoscopic Submucosal Dissection: A Meta-Analysis

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Review

Histamine2-Receptor Antagonists, Proton Pump Inhibitors, or Potassium-Competitive Acid Blockers Preventing Delayed Bleeding After Endoscopic Submucosal Dissection: A Meta-Analysis

Xin Jiang et al. Front Pharmacol.

Abstract

Background: Endoscopic submucosal dissection (ESD) was commonly used for en bloc resection in gastric cancer and adenoma with the risk of delayed bleeding after ESD. We conducted a direct and indirect comparison meta-analysis to evaluate the best choice in preventing post-ESD bleeding among proton pump inhibitors (PPIs), histamine2-receptor antagonists (H2RAs), and the most widely used potassium-competitive acid blocker, vonoprazan. Methods: The Pubmed, Cochrane Library, and Embase were searched for randomized trials. We pooled odds ratios (OR) for preventing post-ESD bleeding using meta-analysis. Results: Sixteen randomized trials met the inclusion criteria including 2,062 patients. Direct comparisons showed slightly significant efficacy in PPIs rather than H2RAs in preventing post-ESD bleeding [OR: 1.83; 95% confidence interval (CI): 1.10 to 3.05] and vonoprazan was better than PPIs (OR: 0.46; 95% CI: 0.25 to 0.86). The adjusted indirect comparison indicated vonoprazan was superior to H2RAs (OR: 0.30, 95% CI: 0.12 to 0.74). In subgroup analysis, PPIs had similar efficacy as H2RAs in 4 weeks, while PPIs were better than H2RAs in 8 weeks' treatment (OR: 1.91; 95% CI: 1.08 to 3.40). The superiority of vonoprazan than PPIs was more significant in combination therapy (OR: 0.18; 95% CI: 0.04 to 0.69). There was a significant difference in vonoprazan for 8 weeks of medication (OR: 0.44; 95% CI: 0.21 to 0.92). Conclusions: The effects of vonoprazan is better than PPIs than H2RAs in preventing bleeding after ESD. When vonoprazan combined with mucosal protective antiulcer drug in treatment or used in 8 weeks of medication, the efficacy may be even better.

Keywords: delayed bleeding; endoscopic submucosal dissection; histamine2-receptor antagonists; proton pump inhibitors; vonoprazan.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses flowchart of the studies included in the meta-analysis.
Figure 2
Figure 2
The meta-analysis of delayed bleeding for H2RAs with PPIs.
Figure 3
Figure 3
The medication duration subgroup meta-analysis of delayed bleeding for H2RAs with PPIs.
Figure 4
Figure 4
The medication regimen subgroup meta-analysis of delayed bleeding for H2RAs with PPIs.
Figure 5
Figure 5
The meta-analysis of delayed bleeding for vonoprazan with PPIs.
Figure 6
Figure 6
The medication duration subgroup meta-analysis of delayed bleeding for vonoprazan with PPIs.
Figure 7
Figure 7
The medication regimen subgroup meta-analysis of delayed bleeding for vonoprazan with PPIs.
Figure 8
Figure 8
The leave-one-out sensitivity analysis of preventing bleeding after ESD per medication option.
Figure 9
Figure 9
Funnel plot of the standard error of publication bias for H2RAs with PPIs.
Figure 10
Figure 10
Egger’s plot of the standard error of publication bias for H2RAs with PPIs.
Figure 11
Figure 11
Funnel plot of the standard error of publication bias for vonoprazan with PPIs.
Figure 12
Figure 12
Egger’s plot of the standard error of publication bias for vonoprazan with PPIs.

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