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Review
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Korean J Med. 2006;71(1):218-218.
- Healing rate and related factors of endoscopic submucosal dissection induced ulcer after pantoprazole therapy for 4 weeks
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Tae-Hoon Oh *, Hwoon-Yong Jung, Kee Don Choi, Gin Hyug Lee, Ho June Song, Seong Soo Hong, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim
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- Healing rate and related factors of endoscopic submucosal dissection induced ulcer after pantoprazole therapy for 4 weeks
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을지의과대학교 내과
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- Abstract
- Background/Aims
Although artificial ulcer caused by endoscopic mucosal resection (EMR) is thought to heal faster and to recur less
often than non-iatrogenic peptic ulcer. There is no consensus regarding healing degree of EMR-induced ulcer and optimal duration of
proton pump inhibitor (PPI) treatment. Recently endoscopic submucosal dissection (ESD) is being widely used as a reliable method for
thorough pathologic examination regardless of tumor size. The aim of this study was to evaluate healing rate and related factors of
ESD-induced ulcer after pantoprazole therapy for 4 weeks. Methods : A total of 56 patients who have underwent ESD for adenoma or
early gastric cancer were enrolled and they performed follow-up endoscopy to evaluate healing degree of ulcer after pantoprazole therapy
(40 mg per day) for 4 weeks. We compared the size of ulcer between initial ESD-induced ulcer and follow-up ulcer at 4 week later and
relevant factors to healing degree of ulcer including age, sex, procedure time, type of dissecting knife, location of neoplasm, presence of
complication, comorbidity and pathologic diagnosis. Results : Median age was 62 (range: 45-87), male to female ratio was 4.6:1, median
size of tumor was 15 mm (range: 3-93), median size of initial specimen was 45 mm (range: 5-95), median size of ESD-induced ulcer
at 4 week was 4 mm (range: 0-30). Twenty-eight (50%) patients had large ulcer (area > 10 mm2) on the follow-up endoscopy at 4 week.
The size of ESD-induced ulcer at 4 week was closely correlated with that of initial specimen (p<0.001). Initial ESD-induced ulcer which
was less than 3 cm in diameter was almost included in small ulcer group at 4 week, while the size of ulcer at 4 week abruptly increased
when that of initial ulcer was larger than 4 cm. Comorbidity, procedure time and initial specimen size were significantly associated with
healing rate (p<0.001). However, the only parameter which had significant value in multivariate analysis was specimen size (initial ulcer
size). Conclusions : Healing rate of ESD-induced ulcer at 4 week is depending on the initial ulcer size. Initial ESD-induced ulcer
especially which is larger than 4cm in diameter should be treated with PPI for more than 4 weeks.
Keywords :
