Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 12/2015

01-12-2015

Risk factors of delayed ulcer healing after gastric endoscopic submucosal dissection

Authors: Joo Hyun Lim, Sang Gyun Kim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung

Published in: Surgical Endoscopy | Issue 12/2015

Login to get access

Abstract

Background

Although post-endoscopic submucosal dissection (ESD) iatrogenic ulcer is known to heal faster than peptic ulcer, some iatrogenic ulcers show delayed healing. The aim of this study was to clarify risk factors of delayed ulcer healing after gastric ESD.

Methods

We retrospectively reviewed medical records of all patients who had ESD for gastric neoplasms (866 adenomas and 814 early gastric cancers) between January 2005 and February 2011.

Results

Of 1680 subjects, 95 had delayed ulcer healing in 3-month follow-up. Multivariate analysis showed that diabetes (OR 1.743; 95 % CI 1.017–2.989, p = 0.043), coagulation abnormality (OR 3.195; 95 % CI 1.535–6.650, p = 0.002), specimen size greater than 4 cm (OR 2.999; 95 % CI 1.603–5.611, p = 0.001), and electrocoagulation (OR 7.149; 95 % CI 1.738–29.411, p = 0.006) were revealed to be independent risk factors of delayed ulcer healing. Meanwhile, persistent Helicobacter pylori infection was not related to the delayed ulcer healing.

Conclusions

Large iatrogenic ulcer by ESD with massive hemostasis, especially in patients with diabetes mellitus or coagulation abnormalities, tends to take more than 3 months to heal. For such cases, initial dosage increment of PPI or addition of other anti-ulcer agents after ESD may be beneficial.
Literature
1.
Oda I, Gotoda T, Hamanaka H, Eguchi T, Saito Y, Matsuda T et al (2005) Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc 17:54–58CrossRef
2.
Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H et al (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58:331–336CrossRefPubMed
3.
Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY et al (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD study group multicenter study. Gastrointest Endosc 69:1228–1235CrossRefPubMed
4.
5.
Kakushima N, Fujishiro M, Kodashima S, Kobayashi K, Tateishi A, Iguchi M et al (2006) Histopathologic characteristics of gastric ulcers created by endoscopic submucosal dissection. Endoscopy 38:412–415CrossRefPubMed
6.
Lee SY, Kim JJ, Lee JH, Kim YH, Rhee PL, Paik SW et al (2004) Healing rate of EMR-induced ulcer in relation to the duration of treatment with omeprazole. Gastrointest Endosc 60:213–217CrossRefPubMed
7.
Kakushima N, Fujishiro M, Yahagi N, Kodashima S, Nakamura M, Omata M (2006) Helicobacter pylori status and the extent of gastric atrophy do not affect ulcer healing after endoscopic submucosal dissection. J Gastroenterol Hepatol 21:1586–1589CrossRefPubMed
8.
Kobayashi M, Takeuchi M, Hashimoto S, Mizuno K, Sato Y, Narisawa R et al (2012) Contributing factors to gastric ulcer healing after endoscopic submucosal dissection including the promoting effect of rebamipide. Dig Dis Sci 57:119–126CrossRefPubMed
9.
Oh TH, Jung HY, Choi KD, Lee GH, Song HJ, Choi KS et al (2009) Degree of healing and healing-associated factors of endoscopic submucosal dissection-induced ulcers after pantoprazole therapy for 4 weeks. Dig Dis Sci 54:1494–1499CrossRefPubMed
10.
Ye BD, Cheon JH, Choi KD, Kim SG, Kim JS, Jung HC et al (2006) Omeprazole may be superior to famotidine in the management of iatrogenic ulcer after endoscopic mucosal resection: a prospective randomized controlled trial. Aliment Pharmacol Ther 24:837–843CrossRefPubMed
11.
Ohya TR, Endo H, Kawagoe K, Yanagawa T, Hanawa K, Ohata K et al (2010) A prospective randomized trial of lafutidine vs rabeprazole on post-ESD gastric ulcers. World J Gastrointest Endosc 2:36–40PubMedCentralCrossRefPubMed
12.
13.
Kim WH, Park CK, Kim YB, Kim YW, Kim HG, Bae HI et al (2005) A standardized pathology report for gastric cancer. Korean J Pathol 39:106–113
14.
Lim JH, Kim SG, Kim JW, Choi YJ, Kwon J, Kim JY et al (2012) Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms? Gastrointest Endosc 75:719–727CrossRefPubMed
15.
Lim JH, Kim SG, Choi J, Im JP, Kim JS, Jung HC et al. (2014) Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms. Gastric Cancer 2014 Oct 18 [Epub ahead of print]
16.
Choi J, Kim SG, Yoon H, Im JP, Kim JS, Kim WH et al (2014) Eradication of Helicobacter pylori after endoscopic resection of gastric tumors does not reduce incidence of metachronous gastric carcinoma. Clin Gastroenterol Hepatol 12:793–800CrossRefPubMed
17.
Kakushima N, Yahagi N, Fujishiro M, Iguchi M, Oka M, Kobayashi K et al (2004) The healing process of gastric artificial ulcers after endoscopic submucosal dissection. Dig Endosc 16:327–331CrossRef
18.
Kawano S, Okada H, Kawahara Y, Hori K, Tanioka D, Tsuzuki T et al (2011) Proton pump inhibitor dose-related healing rate of artificial ulcers after endoscopic submucosal dissection: a prospective randomized controlled trial. Digestion 84:46–53CrossRefPubMed
19.
Park HJ, Kim HS, Kim BR, Park SY, Hong JH, Jo KW et al (2013) Half-dose rabeprazole has an equal efficacy to standard-dose rabeprazole on endoscopic submucosal dissection-induced ulcer. Dig Dis Sci 58:1054–1064CrossRefPubMed
20.
Konturek PC, Brzozowski T, Burnat G, Szlachcic A, Koziel J, Kwiecien S et al (2010) Gastric ulcer healing and stress-lesion preventive properties of pioglitazone are attenuated in diabetic rats. J Physiol Pharmacol 61:429–436PubMed
21.
Harsch IA, Brzozowski T, Bazela K, Konturek SJ, Kukharsky V, Pawlik T et al (2003) Impaired gastric ulcer healing in diabetic rats: role of heat shock protein, growth factors, prostaglandins and proinflammatory cytokines. Eur J Pharmacol 481:249–260CrossRefPubMed
22.
Kim SG, Song HJ, Choi IJ, Cho WY, Lee JH, Keum B et al (2013) Helicobacter pylori eradication on iatrogenic ulcer by endoscopic resection of gastric tumor: a prospective, randomized, placebo-controlled multi-centre trial. Dig Liver Dis 45:385–389CrossRefPubMed
23.
Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y et al (2008) Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection—an analysis of risk factors. Endoscopy 40:179–183CrossRefPubMed
24.
Cheon JH, Kim JH, Lee SK, Kim TI, Kim WH, Lee YC (2008) Helicobacter pylori eradication therapy may facilitate gastric ulcer healing after endoscopic mucosal resection: a prospective randomized study. Helicobacter 13:564–571CrossRefPubMed
25.
Arkkila PE, Seppala K, Kosunen TU, Haapiainen R, Kivilaakso E, Sipponen P et al (2003) Eradication of Helicobacter pylori improves the healing rate and reduces the relapse rate of nonbleeding ulcers in patients with bleeding peptic ulcer. Am J Gastroenterol 98:2149–2156CrossRefPubMed
26.
Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M et al (2001) Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 345:784–789CrossRefPubMed
27.
Kato T, Araki H, Onogi F, Ibuka T, Sugiyama A, Tomita E et al (2010) Clinical trial: rebamipide promotes gastric ulcer healing by proton pump inhibitor after endoscopic submucosal dissection—a randomized controlled study. J Gastroenterol 45:285–290CrossRefPubMed
28.
Shin WG, Kim SJ, Choi MH, Kim KO, Jang HJ, Park CH et al (2012) Can rebamipide and proton pump inhibitor combination therapy promote the healing of endoscopic submucosal dissection-induced ulcers? A randomized, prospective, multicenter study. Gastrointest Endosc 75:739–747CrossRefPubMed
29.
Fujiwara S, Morita Y, Toyonaga T, Kawakami F, Itoh T, Yoshida M et al (2011) A randomized controlled trial of rebamipide plus rabeprazole for the healing of artificial ulcers after endoscopic submucosal dissection. J Gastroenterol 46:595–602CrossRefPubMed
Metadata
Title
Risk factors of delayed ulcer healing after gastric endoscopic submucosal dissection
Authors
Joo Hyun Lim
Sang Gyun Kim
Jeongmin Choi
Jong Pil Im
Joo Sung Kim
Hyun Chae Jung
Publication date
01-12-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4123-z

Other articles of this Issue 12/2015

Surgical Endoscopy 12/2015 Go to the issue

OriginalPaper

Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis

OriginalPaper

Long-term effects of anti-reflux surgery on the physiology of the esophagogastric junction

OriginalPaper

Significant pressure differences between solid-state and water-perfused systems in lower esophageal sphincter measurement

OriginalPaper

Laparoscopic partial nephrectomy in duplex kidneys in infants and children: results of an European multicentric survey

OriginalPaper

Evaluation of safety profile of thoracoscopic esophagectomy for T1bN0M0 cancer using data from JCOG0502: a prospective multicenter study

Review

Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme