Rebamipide with Proton Pump Inhibitors (PPIs) versus PPIs Alone for the Treatment of Endoscopic Submucosal Dissection-Induced Ulcers: A Meta-analysis

Abstract

Objective. To contrast the effect of rebamipide with proton pump inhibitors (PPIs) versus PPIs alone for the treatment of endoscopic submucosal dissection (ESD-) induced ulcers. Methods. PubMed, Embase, the Cochrane library, the WanFang database, and China National Knowledge Infrastructure (CNKI) were searched to identify studies that met the inclusion criteria. Results. Nine randomized controlled trials (RCTs) were recognized, including 1170 patients. In general, rebamipide plus PPIs acted better than PPIs alone against ESD-induced ulcers at four weeks ( $\text{RR}=1.42$ , 95% CI: 1.13-1.78, $P=0.003$ ) but showed no significant differences at eight weeks ( $\text{RR}=1.03$ , 95% CI: 0.97-1.10, $P=0.315$ ). The use of rebamipide plus PPIs was superior to PPIs alone for ESD-induced ulcers greater than 20 mm in size (20-40 mm: $\text{RR}=1.98$ , 95% CI: 1.22-3.23, $P=0.006$ ; >40 mm: $\text{RR}=5.14$ , 95% CI: 1.49-17.74, $P=0.010$ ). In addition, rebamipide plus PPI therapy was discovered to be significantly more effective than PPIs alone for lower ESD-induced ulcers ( $\text{RR}=1.82$ , 95% CI: 1.04-3.20, $P=0.037$ ). There were no significant differences between the treatment groups with the ulcer reduction rate. Conclusion. Evidences now available show rebamipide plus PPIs is practical for protecting against ESD-induced ulcers at four weeks but not at eight weeks, especially large ulcers (>20 mm). However, we still need more high-quality RCTs in the future to supplement our conclusions.