Comparison between Intravenous Pantoprazole and Oral Lansoprazole about the Prevention against Bleeding after Endoscopic Submucosal Dissection

Lee, Chang Geun; Hahn, Suk Jae; Lim, Yun Jeong; Kang, Hyoun Woo; Kim, Jae Hak; Lee, Jun Kyu; Koh, Moon Soo; Lee, Jin Ho; Yang, Chang Hun

doi:2014.14.2.103

Korean J Helicobacter Up Gastrointest Res > Volume 14(2); 2014 > Article

Original Article

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2014;14(2):103-107.
DOI: https://doi.org/10.7704/kjhugr.2014.14.2.103 Published online June 10, 2014.

Comparison between Intravenous Pantoprazole and Oral Lansoprazole about the Prevention against Bleeding after Endoscopic Submucosal Dissection

Chang Geun Lee, Suk Jae Hahn, Yun Jeong Lim, Hyoun Woo Kang, Jae Hak Kim, Jun Kyu Lee, Moon Soo Koh, Jin Ho Lee, Chang Hun Yang

Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. limyj@dongguk.ac.kr

내시경적 점막하 박리술 후 Pantoprazole 주사와 경구 Lansoprazole의 위액 산도를 통한 출혈 예방 효과 비교

이창근*, 한석재*, 임윤정, 강현우, 김재학, 이준규, 고문수, 이진호, 양창헌

동국대학교일산병원 소화기내과

Abstract

BACKGROUND/AIMS
Proton pump inhibitor (PPI) is generally prescribed to prevent post endoscopic submucosal dissection (ESD) bleeding. However, there was no consensus about the effectiveness of intravenous (IV) or oral PPI. We conducted this investigation to evaluate whether oral PPI can be also safely and effectively used to prevent post-ESD bleeding by measurement of intragastric pH. MATERIALS AND METHODS: Patients were assigned in the fixed order to IV pantoprazole by 40 mg every 12 hours and oral lansoprazole fast disintegrating tablet (LFDT) by 30 mg every 8 hours. We checked intragastric pH and hemoglobin (Hb) levels at pre and post-ESD procedure. RESULTS: A total of 10 patients (LFDT group: 6 patients, IV pantoprazole group: 4 patients) were included. There was no difference of baseline Hb level between two groups (LFDT, 14.38+/-0.46 mg/dL; IV pantoprazole, 13.85+/-0.83 mg/dL; P=0.18). After 24 hours, change of Hb level was not different between LFDT (0.95+/-0.30 mg/dL) and IV pantoprazole group (0.98+/-0.45 mg/dL; P=0.96). Baseline intragastric pH was 3.72+/-0.19 with LFDT and 4.31+/-0.41 with IV pantoprazole group (P=0.18). After 24 hours, there was no significant difference of the extent of pH increase between LFDT (2.38+/-0.28) and IV pantoprazole group (2.17+/-0.21; P=0.60). CONCLUSIONS: There was no difference in both the increase of post-24 hour intragastric pH and decrease of post-24 hour Hb between LFDT and IV pantoprazole group. Oral PPI regimen may be able to replace IV PPI therapy for the prevention of post-ESD bleeding and LFDT might be superior to IV PPIs in the aspect of cost-effectiveness.

Key Words: Endoscopic; Submucosal; Dissection; Bleeding; Proton pump inhibitors