Vonoprazan is superior to proton pump inhibitors (PPIs) in healing artificial ulcers post-endoscopic submucosal dissection (ESD) of the stomach: a propensity score-matching analysis

Background and Aim

Proton pump inhibitors (PPIs) are effective in healing artificial ulcers after endoscopic submucosal dissection (ESD) for gastric neoplasms; however, the efficacy of vonoprazan is not completely understood. The aim of this study was to determine the healing effect of vonoprazan on artificial ulcers post-gastric ESD relative to PPI.

Methods

Thirty-five patients who underwent gastric ESD between April and November 2015 were treated with vonoprazan 20 mg/day for 4 weeks and subsequently underwent endoscopy for evaluation of ulcer size (V group). The ulcer contraction rate was determined by the following formula: ([ESD specimen size] – [ulcer size at 4 weeks after ESD])/(ESD specimen size) x 100%. We compared the results with those of a historical control group treated with esomeprazole 20 mg/day for 4 weeks after gastric ESD and subsequently measured their ulcer size (33 patients, E group) by propensity score-matching methods.

Results

Sixty-two subjects were enrolled after propensity score-matching. The ulcer contraction rate at 4 weeks after ESD in the V group was significantly higher than that of the E group (97.7 ± 3.2% vs. 94.5 ± 6.7%, respectively, p = 0.025). The number of subjects with a scar-stage ulcer (100% contraction rate) tended to be higher in the V group relative to the E group (32% [10 of 31] vs. 13% [4 of 31], respectively, p = 0.070, McNemar's chi-squared test).

Conclusions

Vonoprazan has a faster post-gastric ESD artificial ulcer contraction rate than esomeprazole. Vonoprazan may supersede PPIs in treating post-ESD artificial ulcers of the stomach.

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