Risk Factors for Delayed Ulcer Healing after Endoscopic Submucosal Dissection of Gastric Neoplasms

Abstract

Background & Aims: With improved technology, the size of artificial ulcers after endoscopic submucosal dissection (ESD) has increased. The aim of our study was to examine the risk factors for delayed gastric ulcer healing after ESD, including the possible benefit of potassium-competitive acid blocker (P-CAB) treatment.Methods: The primary outcome was the rate of healing of the artificial ulcers induced by ESD at 8 weeks post intervention. Design: retrospective case series. Setting: Aichi Medical University Hospital. Patients: patients who underwent ESD for gastric neoplasm, between April 2015 and March 2017. Intervention: ESD, with a follow-up endoscopic examination at 8 weeks post-ESD. Univariate and multivariate analyses were used to identify the independent risk factors for delayed healing.Results: Of the 73 gastric neoplasms included in the analysis, delayed ulcer healing was identified in 21.9%. Dyslipidemia (p=0.04), ESD procedure time (p=0.003) and artificial ulcer size (p<0.001) were identified as risk factors for delayed healing, with location in the lower third of the stomach [Odds ratio (OR) 6.76; p=0.016] and artificial ulcer size (OR, 1.18; p=0.024) retained as independent risk factors. A cut-off ulcer size of 854 mm2 was predictive of delayed healing, with a sensitivity of 29.8% and specificity of 87.5%. For large ulcers, the rate of healing of 70% with vonoprazan was higher than the rate of 47.6% with proton pump inhibitors (PPIs), although this difference was not significant.Conclusion: For artificial ulcers after ESD with a resection diameter >35 mm, it might be desirable to use PPIs for >8 weeks or P-CAB.Abbreviations: EGC: early gastric cancers; EMR: endoscopic mucosal resection; ESD: endoscopic submucosal dissection; H. pylori: Helicobacter pylori; H2RA: H2-receptor antagonist: PRP: platelet rich plasma; PGA: polyglycolic acid; P-CAB: potassium-competitive acid blocker; PPI: proton pump inhibitor.