Imaeda, H., Hosoe, N., Suzuki, H., Saito, Y., Ida, Y., Nakamura, R., . . . Hibi, T. (2011). Effect of lansoprazole versus roxatidine on prevention of bleeding and promotion of ulcer healing after endoscopic submucosal dissection for superficial gastric neoplasia. Journal of Gastroenterology, 46(11), 1267–1272.
To compare the effects of a proton-pump inhibitor (PPI) and a histamine 2 receptor antagonist on the prevention of bleeding and promotion of ulcer healing after endoscopic submucosal dissection (ESD) for superficial gastric neoplasia with a secondary aim to compare the cost effectiveness of the two drugs
Patients were randomly assigned to receive either lansoprazole (30 mg IV bid for two days followed by 30 mg PO qd x eight weeks) or roxatidine (75 mg IV bid for two days followed by 75 mg bid x eight weeks). Medication was started the morning following the ESD. Follow-up EGDs were performed the day after the ESD, and at eight weeks. Endoscopists were blind to study groups. Endoscopy was performed the day after ESD, and at the eight week follow-up. CBC drawn the day after ESD. Medication compliance was determined with the remaining medication count at week eight. No discussion of reliability or validity of EGD.
Prospective, randomized, controlled trial
There was no significant difference in major (p = 0.68) or minor (p = 1) bleeding between the two groups; there was no significant difference in ulcer healing between the two groups (p = 1). There was a large cost/benefit ratio associated with roxatidine.
There was no difference in bleeding incidence or ulcer healing in subjects after ESD for superficial gastric neoplasia. Additionally, given the cost difference, there is no evidence to support the preferential use of lansoprazole over roxatidine.
Nurses will care for patients with gastric neoplasia post-ESD and need to be cognizant of the risk of bleeding and the potential effect of PPI or histamine 2 receptor antagonists upon this risk.