Tu1484 Comparison of Colon Cleansing With Two Liters of Polyethylen Glycol-Ascorbic Acid Versus Three Liters of Polyethylen Glycol-Electrolyte: A Prospective and Randomized Study

Abstract

Background: Endoscopic submucosal dissection (ESD) is a breakthrough technique in the treatment of superficial gastrointestinal neoplasms. Associated serious complications, such as the ESD-related bleeding and perforation, have decreased with technical and procedural improvements. However, prevention of delayed bleeding still requires improvement. On the other hand, acceleration of mucosal healing may contribute to lowering the frequency of delayed bleeding. Administration of a proton pump inhibitor(PPI)alone is the usual treatment for post-ESD ulcers. To accelerate ESD-induced ulcer healing, several reports have advocated adding mucosal-protective agents to PPI. However, as yet, there have been no trials comparing two such groups, i.e., PPI alone versus PPI plus a mucosal-protective agent. Therefore, to clarify additive benefits, we examined three groups: PPI alone, and PPI plus one of two mucosal-protective agents, either rebamipide or polaprezinc. Methods: A total of 90 patients undergoing ESD performed by one physician for superficial gastrointestinal neoplasms were randomly allocated into three groups (n 30 each): Omeprazole 20 mg/day only (OMZ group), OMZ plus rebamipide 300 mg/day (REB group), or OMZ plus polaprezinc 150 mg/day (PPZ group). The diminution rates of post-ESD ulcers after 4 weeks were determined by endoscopy and compared among the three groups. Parameters determined were the total rate, location (gastric antrum, body) and size ( 600mm2, 600 to 900mm2, 900mm2 ) of lesions. Results: The total diminution rate was 94.4 12.2 in the OMZ group, 97.8 3.1 in the REB group, and 97.7 2.3 in the PPZ group. There were no significant differences among the groups in either the location or the size of lesions. However, the OMZ group showed marked deviation, statistically. Conclusion: Our results show that therapy combining PPI with mucosal-protective agents does not accelerate post-ESD ulcer healing. However, the healing efficacy of PPI alone administration was extremely variable. Therefore, mucosal-protective agents might contribute to stabilizing the efficacy of post-ESD ulcer healing.