AI Insight
This network meta-analysis of 31 randomized controlled trials compared seven different drug regimens for promoting ulcer healing and preventing complications after gastric endoscopic submucosal dissection (ESD). While P-CAB-based treatments and combination therapies with mucosal protectants showed numerically favorable trends for early ulcer healing at 4 weeks, no regimen demonstrated statistically significant superiority over standard proton pump inhibitor (PPI) therapy, and all treatments showed comparable safety profiles for preventing delayed bleeding or perforation.
Why it matters
The findings suggest that standard PPI therapy remains a reasonable first-line option after gastric ESD, as newer and potentially more expensive alternatives have not demonstrated clear statistical superiority. This information can guide clinical decision-making and resource allocation in post-procedural care for patients undergoing this increasingly common endoscopic procedure.
by Linqiang Li, Xiaowei Zhu, Hengda Hu
Background
Gastric ESD induces large mucosal defects with potential delayed complications, including bleeding and perforation. The comparative efficacy of pharmacological regimens—PPI, P-CAB, H2RA, MP, and their combinations—remains unclear.
Methods
We conducted a frequentist network meta-analysis of 31 randomized controlled trials evaluating seven pharmacological strategies for post-ESD ulcer healing and delayed bleeding prevention. Outcomes were assessed at 4 and 8 weeks for mucosal healing and ulcer reduction, and across the treatment course for delayed bleeding/perforation. Odds ratios (ORs), mean differences (MDs), and P-scores were calculated. Heterogeneity, inconsistency, sensitivity, and publication bias were assessed. Transitivity was evaluated qualitatively, and certainty of evidence was rated using the GRADE framework.
Results
At 4 weeks, the point estimate for P-CAB monotherapy favored PPI (OR=1.61, 95%CI 0.96–2.68, P = 0.069), but the confidence interval included the null value and the difference was not statistically significant; P-CAB had the highest numerical P-score ranking; combination regimens (PPI + MP, P-CAB + MP) also yielded numerically better healing outcomes. At 8 weeks, PPI + MP had the highest numerical P-score ranking, though no regimen achieved statistically superior healing compared with PPI. For delayed bleeding and perforation, all regimens demonstrated comparable safety profiles, while H2RA-based treatments showed a non-significant trend toward higher complication risk. Most pairwise comparisons were supported by low-to-moderate certainty evidence.
Conclusions
While P-CAB-based regimens and MP combinations showed numerically favorable trends for early post-ESD ulcer healing, all comparative findings are limited by mostly low-to-moderate GRADE evidence certainty, and no regimen exhibited statistically significant superiority for ulcer healing. No regimen significantly reduces delayed bleeding or perforation risk.