Tu1444 How Many Days in Advance Should Proton Pump Inhibitor (PPI) Administration Be Started to Prevent Bleeding After Endoscopic Submucosal Dissection? Prospective Randomized Trial of PPI Administration

Tu1444 How Many Days in Advance Should Proton Pump Inhibitor (PPI) Administration Be Started to Prevent Bleeding After Endoscopic Submucosal Dissection? Prospective Randomized Trial of PPI Administration Takuto Hikichi, Masaki Sato, Atsushi Irisawa, Tadayuki Takagi, Tsunehiko Ikeda, Rei Suzuki, Kou Watanabe, Jun Nakamura, Hiromasa Ohira, Katsutoshi Obara Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; Gastroenterology and Rheumatology, Fukushima Medical University, Fukushima, Japan; Preparatory Office for Aizu Medical Center, Fukushima Medical University, Fukushima, Japan Background: Endoscopic submucosal dissection (ESD) is widely performed as a standard endoscopic therapy for early gastric cancer. However, post-procedural bleeding is a big problem. Although a proton pump inhibitor (PPI) is administered before ESD to prevent the bleeding by raising gastric pH (G-pH), there have been few assessment reports regarding its administration. Therefore, we attempted to establish an appropriate PPI administration schedule. Methods: The PPI used in this study was rabeprazole sodium (RPZ), which is well known for its rapid effect in raising G-pH. A total of 55 patients who underwent ESD for early gastric carcinoma or adenoma from November 2007 through November 2008 and gave informed consent to participate in this trial were enrolled. These patients were randomly divided into two groups: Group A consisting of 24 patients who took RPZ 20 mg/day from three days before the day of ESD through the morning of ESD, and Group B consisting of 31 patients who took RPZ 20 mg/day only on the morning of ESD. Administration of RPZ on the morning of ESD was made at least seven hours before the procedure so that its optimal effect was achieved. G-pH was measured three times: one month before ESD (pre-ESD pH), just before ESD (immediate pre-ESD pH), and one week after ESD (post-ESD pH). The frequency of post-procedural bleeding and G-pH were compared between Groups A and B. Results: Post-procedural bleeding occurred in no patients in Group A, but in one patient in Group B. The immediate preESD and post-ESD pHs were significantly higher than the pre-ESD pH in both Group A (7.20 0.58 and 6.92 1.45 vs. 4.99 2.03) and Group B (6.53 1.11 and 6.87 1.46 vs. 4.78 2.45) (P 0.001). The post-ESD pH was not significantly different between the two groups; however, the immediate pre-ESD pH was significantly higher in Group A (P 0.007), although that of Group B was above 5.4, the lowest level required to prevent and control post-procedural bleeding. Conclusion: These results suggest that the administration of PPI at least seven hours before ESD is effective enough to prevent bleeding after ESD, although its administration started three days before the day of ESD is more advisable.