Otsuka T, Sugimoto M, Ban H, Nakata T, Murata M, Nishida A, Inatomi O, Bamba S, Andoh A. Severity of gastric mucosal atrophy affects the healing speed of post-endoscopic submucosal dissection ulcers. World J Gastrointest Endosc 2018; 10(5): 83-92 [PMID: 29774087 DOI: 10.4253/wjge.v10.i5.83]
Corresponding Author of This Article
Mitsushige Sugimoto, MD, PhD, Associate Professor, Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu 520-2192, Japan. sugimo@belle.shiga-med.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Table 2 Characteristics of patients who achieved early healing of artificial ulcer area after endoscopic submucosal dissection
Reduction rate over 90% at 4 wk
Reduction rate 100% at 8 wk
Characteristic
Achieved (n = 82)
Not achieved (n = 45)
P value
Achieved (n = 110)
Not achieved (n = 16)
P value
Age (yr)
70.9 ± 9.3
71.2 ± 7.3
0.831
70.4 ± 8.9
74.1 ± 6.2
0.047
Gender (male/female)
62/20 (75.6%/24.4%)
33/12 (73.3%/26.7%)
0.777
86/24 (78.2%/21.8%)
8/8 (50.0%/50.0%)
0.021
H. pylori (positive/negative)
42/40 (51.2%/48.8%)
24/21 (53.3%/46.7%)
0.82
54/56 (49.1%/50.9%)
12/4 (75.0%/25.0%)
0.053
Anti-coagulants
13 (15.9%)
8 (17.8%)
0.78
16 (14.5%)
4 (25.0%)
0.231
PPI or PCAB (post-ESD)
60/22 (73.2%/26.8%)
32/13 (71.1%/28.9%)
0.804
82/28 (74.5%/25.5%)
14/2 (87.5%/12.5%)
0.210
CYP2C19 type (EM/IM/PM)
27/28/15 (38.6/40/21.4)
12/20/7 (30.8/51.3/17.9)
0.522
35/39/19 (37.6/41.9/20.5)
4/9/1 (28.6%/64.3%/7.1%)
0.249
Gastric mucosa
Trophy (Kyoto A0+A1/Kyoto A2)
18/64 (22.0%/78.0%)
2/43 (4.0%/96.0%)
0.01
19/91 (17.3%/82.7%)
1/15 (6.3%/93.7%)
0.233
Metaplasia (none-mild/severe)
51/31 (62.2/37.8)
21/24 (46.7/53.3)
0.091
64/46 (58.2/41.8)
8/8 (50.0/50.0)
0.537
Diffuse redness (none-mild/severe)
44/38 (53.7/46.3)
21/24 (46.7/53.3)
0.451
60/50 (54.5/45.5)
7/9 (43.8/56.2)
0.419
Tumor
Depth (mucosa/submucosa)
78/4 (95.1/4.9)
35/10 (77.8/22.2)
0.004
101/9 (91.8 /8.2)
15/1 (93.8/6.2)
0.629
Location (upper/middle/lower third)
7/39/36/ (8.5/47.6/43.9)
7/26/12 (15.6/57.8/26.6)
0.124
12/58/40 (10.9/52.7/36.4)
2/7/7 (12.4/43.8/43.8)
0.797
ESD
Mean procedure time (min)
65.6 ± 41.1
89.7 ± 64.0
0.026
73.9 ± 52.3
76.1 ± 41.4
0.872
Mean resected ulcer area (mm2)
544.7 ± 387.1
809.8 ± 849.8
0.053
567.3 ± 435.2
1178.5 ± 1520.1
0.130
Table 3 Univariate analysis of factors preventing healing of ulcers after endoscopic submucosal dissection
Reduction rate over 90% at 4 wk
Reduction rate 100% at 8 wk
Variable
Not achieved (n = 45)
P value
Not achieved (n = 16)
P value
Age (yr)
1.004 (0.963-1.048)
0.841
1.058 (0.987-1.135)
0.113
Gender (female vs male)
1.127 (0.491-2.588)
0.777
3.583 (1.218-10.545)
0.021
Helicobacter pylori
1.088 (0.525-2.255)
0.820
3.111 (0.945-10.244)
0.053
Lansoprazole vs vonoprazan
1.108 (0.493-2.488)
0.804
0.418 (0.089-1.956)
0.210
Anti-coagulants
1.148 (0.436-3.018)
0.780
1.958 (0.561-6.832)
0.231
CYP2C19 type (EM vs IM/PM)
1.084 (0.635-1.850)
0.768
0.921 (0.420-2.020)
0.838
Atrophy (Kyoto A0+A1 vs Kyoto A2)
6.047 (1.334-27.403)
0.010
3.132 (0.390-25.163)
0.233
Tumor located in upper and middle third (vs lower third)
0.465 (0.211-1.026)
0.055
1.361 (0.471-3.934)
0.568
Mean procedure time (min)
1.009 (1.002-1.017)
0.018
1.001 (0.991-1.011)
0.871
Mean resected ulcer area (mm2)
1.001 (1.000-1.001)
0.032
1.001 (1.000-1.001)
0.013
Table 4 Multivariate analysis of factors preventing healing of ulcers after endoscopic submucosal dissection
Reduction rate over 90% at 4 wk
Reduction rate 100% at 8 wk
Variable
Not achieved (n = 45)
P value
Not achieved (n = 16)
P value
Gender (male vs female)
1.833 (0.715-4.698)
0.207
4.438 (1.253-15.724)
0.021
Helicobacter pylori
1.012 (0.463-2.213)
0.976
3.340 (0.866-12.885)
0.080
Atrophy (Kyoto A0+A1 vs Kyoto A2)
5.678 (1.190-27.085)
0.029
2.764 (0.309-24.711)
0.363
Tumor located in upper and middle third (vs lower third)
0.698 (0.283-1.724)
0.436
1.848 (0.493-6.933)
0.362
Mean procedure time (min)
1.007 (0.997-1.017)
0.194
0.998 (0.982-1.015)
0.850
Mean resected ulcer area (mm2)
1.000 (1.000-1.001)
0.443
1.001 (1.000-1.002)
0.023
Citation: Otsuka T, Sugimoto M, Ban H, Nakata T, Murata M, Nishida A, Inatomi O, Bamba S, Andoh A. Severity of gastric mucosal atrophy affects the healing speed of post-endoscopic submucosal dissection ulcers. World J Gastrointest Endosc 2018; 10(5): 83-92