Healing Rate And Related Factors Of Endoscopic Submucosal Dissection(Esd)-Induced Ulcer After Pantoprazol Therapy For 4 Week

Background/Aims: Although artificial ulcer caused by ESD is thought to heal faster and to recur less often than non-iatrogenic peptic ulcer. There is no consensus regarding healing degree of ESD-induced ulcer and optimal duration of PPI treatment. This study retrospectively evaluated healing rate and related factors of ESD-induced ulcer after pantoprazol therapy for 4 week. Methods: A total of 56 patients who have underwent ESD for adenoma or early stage gastric cancer and performed follow-up endoscopy at 4 week were included. Pantoprazol (40 mg per day) were given to these patient during 4 week. We compared the each size and relevant factors to healing degree of ulcer including age, sex, procedure time, location of neoplasm, presence of complication, comorbidity, drug history such as aspirin or NSAIDs and pathologic diagnosis between initial ESD-induced ulcer and one at 4 week later. Results: Median age was 62 (range: 45-87), sex ratio was 5.6: 1 (male to female), median size of tumor was 15 mm (range: 3-93), median size of initial specimen were 1588 mm2 (range: 5-95), median size of ESD-induced ulcer at 4 week was 11 mm2 (range: 0-30). 28(50%) patients had small ulcer (diameter < 3 mm) on the follow-up endoscopy at 4 week. The size corresponding to root area of ESD-induced ulcer at 4 week was closely correlated with that of initial specimen (p < 0.001). Initial ESD-induced ulcer which was less than 3 cm in diameter was almost included in small ulcer group at 4 week, but ulcer size at 4 week abruptly increased at the point of 4 cm in diameter of initial ulcer. Procedure time and initial specimen size were significantly associated with healing rate (p < 0.001). But the only parameter which had significant value in multivariate analysis was specimen size (initial ulcer size). Conclusions: Healing rate of ESD-induced ulcer at 4 week is depending on the initial ulcer size. Initial ESD-induced ulcer which is larger than 4 cm in diameter should be treated with PPI for more than 4 week.