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Contributing Factors to Gastric Ulcer Healing After Endoscopic Submucosal Dissection Including the Promoting Effect of Rebamipide
Digestive Diseases and Sciences, 08/18/2011
Clinical Article
Kobayashi M et al. – Healing in endoscopic submucosal dissection(ESD)–induced ulcers was dependent on the initial ulcer size. In large–sized ulcers, rebamipide promotes basal healing.
Methods- 170 patients with early gastric cancers that had undergone ESD were enrolled.
- Follow-up endoscopy was scheduled at 4–6 weeks after ESD.
- The authors assessed marginal healing and basal healing independently by endoscopic observation.
- Marginal healing was determined by a regenerating epithelium and/or converging folds around the periphery of the ulcer.
- Basal healing was declared when the ulcer was covered by white coat thinning such that basal granulation could be seen.
- Sizes of the artificial ulcers were divided into normal size (area <1,200 mm2) or large size (area ≥1,200 mm2).
- Initial ulcer size and duration after ESD were significantly correlated with both marginal and basal healing rates by univariate analysis.
- Marginal healing rate of antral lesions was higher than that of body lesions.
- Multivariate analysis showed a large-sized ulcer was the only significant predictor of delayed healing, with delayed healing defined as no observed marginal or basal healing (p< 0.0001).
- Subgroup analysis for the effect of rebamipide on large-sized ulcers showed a significantly higher rate of basal healing in the combination PPI and rebamipide group (p=0.015).