Comparison between Intravenous Pantoprazole and Oral Lansoprazole about the Prevention against Bleeding after Endoscopic Submucosal Dissection

Abstract

BACKGROUND/AIMS: Proton pump inhibitor (PPI) is generally prescribed to prevent post endoscopic submucosal dissection (ESD) bleeding. However, there was no consensus about the effectiveness of intravenous (IV) or oral PPI. We conducted this investigation to evaluate whether oral PPI can be also safely and effectively used to prevent post‐ESD bleeding by measurement of intragastric pH. MATERIALS AND METHODS: Patients were assigned in the fixed order to IV pantoprazole by 40 mg every 12 hours and oral lansoprazole fast disintegrating tablet (LFDT) by 30 mg every 8 hours. We checked intragastric pH and hemoglobin (Hb) levels at pre and post‐ESD procedure. RESULTS: A total of 10 patients (LFDT group: 6 patients, IV pantoprazole group: 4 patients) were included. There was no difference of baseline Hb level between two groups (LFDT, 14.38+/‐0.46 mg/dL; IV pantoprazole, 13.85+/‐0.83 mg/dL; P=0.18). After 24 hours, change of Hb level was not different between LFDT (0.95+/‐0.30 mg/dL) and IV pantoprazole group (0.98+/‐0.45 mg/dL; P=0.96). Baseline intragastric pH was 3.72+/‐0.19 with LFDT and 4.31+/‐0.41 with IV pantoprazole group (P=0.18). After 24 hours, there was no significant difference of the extent of pH increase between LFDT (2.38+/‐0.28) and IV pantoprazole group (2.17+/‐0.21; P=0.60). CONCLUSIONS: There was no difference in both the increase of post‐24 hour intragastric pH and decrease of post‐24 hour Hb between LFDT and IV pantoprazole group. Oral PPI regimen may be able to replace IV PPI therapy for the prevention of post‐ESD bleeding and LFDT might be superior to IV PPIs in the aspect of cost‐effectiveness.