Vonoprazan prevents bleeding from endoscopic submucosal dissection‐induced gastric ulcers. Issue 6 (28th July 2016) - Kagawa, T.
Summary: Background: Vonoprazan, a potassium‐competitive acid blocker, is expected to improve the healing of endoscopic submucosal dissection (ESD)‐induced gastric ulcers compared with proton pump inhibitors (PPIs). Aim: To compare the healing status of ESD‐induced gastric ulcers and the incidence of post‐ESD bleeding between subjects treated with vonoprazan for 5 weeks and those treated with PPIs for 8 weeks. Methods: Patients in the vonoprazan group ( n = 75) were prospectively enrolled, whereas patients in the PPI group ( n = 150) were selected for a 2:1 matched historical control cohort according to baseline characteristics including gastric ulcer size immediately following ESD, age, sex and status of Helicobacter pylori infection. Two controls per case of vonoprazan‐treated group were matched with a margin of 20% in terms of ulcer size and a margin of 5 years in terms of their age. Results: Although a higher number of completely healed ulcers was observed in the PPI group (95/150, 63.3%) than that in the vonoprazan group (14/75, 18.7%; P < 0.001), the ulcer size reduction rates, which were 96.0 ± 6.7% in the vonoprazan group and 94.7 ± 11.6% in the PPI group, were not significantly different ( P = 0.373). The post‐ESD bleeding incidence in the vonoprazan group (1/75, 1.3%) was less than that in the PPI group (15/150, 10.0%; P = 0.01). The factors affecting post‐ESD bleeding incidence were the type of acid secretion inhibitor ( P = 0.016) and use of an anti‐thrombotic agent ( P = 0.014). Conclusion: Vonoprazan significantly reduced post‐endoscopic submucosal dissection bleeding compared with PPIs.