| Objective: To compare the efficacy of proton pump inhibitors(PPIs) with mucosal protective agents versus PPIs alone for the treatment of ulcers after endoscopic submucosal dissection(ESD).Methods: Pubmed、medline、web of science、cochrane Library、embase、CNKI、CBM were searched up to the end of November 2015 in order to identify all randomized controlled trials reporting the effects of PPIs plus mucosal protective agents on healing ulcers after ESD without language restrictions. Meanwhile the references of the included studies were also retrieved manually. Literature selection,data extraction and quality assessment were performed by two independent reviewers,and meta-analysis was performed using Rev Man 5.1 software.Results: A total of nine studies involving 1015 patients were included. The pooled data suggested a significantly higher rate of ulcer healing after ESD among patients treated with PPIs plus mucosal protective agents than among those treated with PPIs alone [odds ratio(OR)= 2.28, 95% confidence interval(CI): 1.66-3.14]. The subgroup analysis showed PPI plus rebamipide therapy to be more effective in healing ESD-induced ulcers than treatment with PPIs alone after both four(OR=2.14,95% CI=1.54-2.98) and eight weeks of treatment(OR=3.33,95% CI=1.54-7.21),especially when the treatment course was 8-week. we found that treatment with PPIs plus mucosal protective agents was more effective in healing ESD-induced ulcers than PPI monotherapy over both ulcers with diameter greater than 40 mm(OR=12.66,95% CI=2.04-78.70) or among 20-40mm(OR=4.52,95%CI=1.88-10.90). especially for those ulcers with diameter >40 mm.Conclusion: The results of this meta-analysis suggest that treatment with PPIs plus mucosal protective agents is superior to PPI monotherapy for healing ESD-induced ulcers, particularly large ulcers. However, more high-quality,large scale and multicenter RCTs are needed to confirm these findings. |
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