내시경적 점막하 박리술 후 출혈에 대한 금식 기간 동안의 양자펌프억제제 정주의 효과

Abstract

Background and Aims Intravenous administration of proton pump inhibitor (IV PPI) has been widely used before and after endoscopic submucosal dissection (ESD) in order to prevent bleeding and heal ulcers. However, its efficacy during the Nil per os (NPO) is controversial. Thus, We aimed to clarify whether IV PPI during the NPO period could prevent post-ESD bleeding.

Methods We performed a retrospective cohort study among a total of 209 patients who underwent complete ESD for adenoma and early gastric cancers (EGCs) between March 2009 and September 2011. Post−ESD coagulation (PEC) using a coagulation forceps and argon plasma coagulation was introduced to all the patients. Age, sex, medications, tumor features (gross type, pathology, size, location, and depth), procedure time, second-look endoscopy, IV PPI during the NPO period, and PEC were investigated.

Results IV PPI was administered to 129 of the 209 patients during the NPO period. Age, sex, comorbidities, histopathologic type, gross type, location, depth, tumor size, procedure time, and the use of IV PPI during the NPO period did not show significant difference in bleeding rate between the groups. Medication (patients who use both aspirin and anti-platelet agents) was the only risk factor for delayed bleeding that showed a significant difference between the groups (P= 0.019).

Conclusions This retrospective cohort study suggested that IV PPI before and after ESD during the NPO period does not reduce the bleeding rate.