Oral administration of proton-pump inhibitor (PPI) helps reduce the risk of delayed bleeding in gastric endoscopic mucosal resection (G-EMR) and gastric endoscopic submucosal dissection (G-ESD) but not in esophageal endoscopic mucosal resection (E-EMR), esophageal endoscopic submucosal dissection (E-ESD), and percutaneous endoscopic gastrostomy (PEG), according to a study.
“Our large-scale population-based study revealed the reduced effect of oral PPI on delayed bleeding in G-ESD and G-EMR but not in E-ESD, E-EMR, and PEG,” the investigators said. “The subgroup and sensitivity analyses almost consistently confirmed the acquired results.”
A total of 172,635 patients provided data for this study. After propensity score matching, reductions in delayed bleeding risk occurred in G-EMR (odds ratio [OR], 0.66, 95 percent confidence interval [CI], 0.52‒0.84) and G-ESD (OR, 0.39, 95 percent CI, 0.30‒0.50) following oral PPI administration. [Am J Gastroenterol 2026;121:1609-1618]
On the other hand, no substantial decrease in delayed bleeding risk was seen in E-EMR (OR, 1.05, 95 percent CI, 0.56‒1.99), E-ESD (OR, 1.09, 95 percent CI, 0.86‒1.38), and PEG (OR, 1.03, 95 percent CI, 0.93‒1.13). These findings almost consistently persisted in subgroup and sensitivity analyses.
“These results indicated that PPI should be administered in G-EMR and G-ESD among the five upper gastrointestinal (GI) endoscopic treatments,” the investigators said.
Previous studies
No direct comparisons on delayed bleeding risk have previously been done between oral PPI administration and no acid-suppressive therapy in G-ESD despite recommendations by the European and Japanese guidelines on PPI use in G-ESD. [Endoscopy 2023;55:361-389; Dig Endosc 2021;33:4-20]
Likewise, the efficacy of oral PPI for delayed bleeding in E-EMR, E-ESD, G-EMR, and PEG is largely still unexplored, according to the investigators.
“This study includes clinical insights on each upper GI endoscopic treatment. In G-ESD, we first found that oral PPI administration reduced delayed bleeding risk. Most patients currently receive acid-suppressive agents for G-ESD in clinical practice, based on the results of a previous randomized trial comparing oral PPI with H2RA,” they said. [Am J Gastroenterol 2007;102:1610-1616]
However, no research has shown reductions in the effect of PPI for delayed bleeding due to the lack of patients undergoing G-ESD without the use of acid-suppressive agents, said the investigators, noting that a large database allowed them to compare bleeding outcomes between oral PPI administration and no acid-suppressive therapy in G-ESD.
“Our results could provide additional evidence on the use of PPI in G-ESD,” they said. “Furthermore, PPI was useful, regardless of whether the standard- or reduced-dose PPI was administered.”
Study details
The current population-based study obtained data from patients prescribed with PPIs or received no acid-suppressive therapy and who underwent E-EMR, E-ESD, G-EMR, G-ESD, or PEG in Japan between 2012 and 2022 from the Diagnosis Procedure Combination database.
Delayed bleeding in each procedure served as the primary outcome. The investigators then conducted propensity score matching to balance the comparison groups and logistic regression analyses to compare bleeding outcomes.
“To the best of our knowledge, we first demonstrated the efficacy of oral PPI administration on reducing delayed bleeding in G-EMR,” the investigators said.