Evaluate The Effect Of Proton Pump Inhibitors Combined With Mucosa Protectanton On The Prevention Of Gastric Ulcer After Gastric ESD With Endoscope Assistant Software(EAS)

Background and Objective:With the continuous development of endoscopic techniques,endoscopic lesions area measurement accuracy requires more and more high,Our team developed a new method of endoscopic lesions area measurement-Endoscope Assistant software in cooperation with the Chinese science and technology university.This study intends to measure the endoscopic ulcer area and surgical specimens area of early gastric cancer after ESD with EAS,to analyse the correlation of the areas in vivo and in vitro with EAS,to verify the feasibility and accuracy of the endoscopic lesions area digital image processing techniques;Another,Compare the ulcer area size intraoperative and postoperative 2 weeks and 4 weeks after ESD.to evaluate the effects of different drug therapy on postoperative ulcer healing,to guide the rationality of clinical drug use.Methods:1 Analysis of reliability of measuring endoscopic leision area with EAS This study collected outpatients who in ills with EGS and requires ESD from April2015 to April 2016 in the first affiliate hospital of Anhui Medical University.EAS method is used to measure the endoscopic ulcer area and surgical specimens area after ESD,record results,using appropriate statistical methods to analyze the correlation.2 Effect of Teprenone Combined with Esomeprazole on Prevention of gastriculcer after Gastric ESD evaluated with EAS Experiments were collected 69 cases of patients who suffer from precancerous lesions or EGC,eliminate the postoperative additional surgery or radiation and lost to follow-up patients,eventually into this test is 64 cases.The patients are divided into drugs combined group of 33 cases,31 cases of PPI group Using the method of random number table.Patients in drug combination group were given teprenone(50mg Tid)combined with esomeprazole(20mg Bid),while patients in PPI group were given PPI(esomeprazole 20 mg Bid)group alone.The treatment course was 4 weeks.Ulcer healing after ESD were evaluated with EAS.Ulcer healing and the rate of complication in the two groups were compared.EAS method is used to measure the ulcer area postoperative 2 weeks,4 weeks in the two groups of patients.Results:1 Analysis of reliability of measuring endoscopic leision area with EAS Collect 64 patients totally,using the method of EAS,the endoscopic ulcer average area was 1510.50±484.22 mm2 and the average surgical specimen area was 961.28±356.99mm2.Endoscopic ulcer area was significantly greater than surgical specimen area,using statistical analysis found that the two areas were positively correlated,correlation coefficient r = 0.978,as the significant correlation.2 Effect of Teprenone Combined with Esomeprazole on Prevention of gastriculcer after Gastric ESD evaluated with EAS(1)Baseline Characteristics Collected 69 patients during the tests,to rule out the additional surgery or radiation therapy after surgery in 3 cases and 2 cases were lost to follow-up,eventually 64 cases into this test,33 cases in drug combination group of,aged 48 to 78 years old,mean age66.88±6.82 years old,male: female 1.75:1;31 cases in PPI group,age 46-79,mean age 66.32 ± 7.33 years old,male: female 1.38:1.Drug combinations and PPI group patients were followed up to 4 weeks after surgery,neither additional surgery or radiotherapy intraoperative and postoperative,no patients died during.There were no statistical difference in patients' age,gender,lesion nature,the size of the wound,and the lesion site of the two groups.(2)Postoperative bleeding and perforation after ESD There is no delayed hemorrhages in Combination group,late-onset bleeding occurred in 1 case in PPI group,stopping the bleeding endoscopically succesfully,no significant statistical difference in the postoperative bleeding rate of the two groups(P =0.484).Intraoperative and postoperative perforation was not seen in the two groups.(3)Situation of area of ulcer healing After two weeks,ulcer area of the two groups are both narrowed considerably,after statistical analysis,about the ulcer area,there is no statistical significance(P > 0.05),4weeks after the operation,ulcer area of the drug combinationg grour is significantly smaller than the PPI group,with statistical difference(P < 0.05).(4)Ulcer stage after ESD2 weeks postoperatively,12 cases of A1,18 cases of A2,3 cases of H1 period in the combination group;16 cases of A1,13 cases of A2,2 cases of H1 in the PPI group,no statistical difference about the ulcer stage(P > 0.05).4 weeks postoperatively,the two groups were mainly healing stage ulcers,6 cases of H1,20 cases of H2,7 cases of S1 period in the combination group;16 cases of H1,12 cases of H2,3 cases of S1 in the PPI group,ulcer healing stage level of drug combination is higher than the PPI group,with statistical difference(P < 0.05).(5)Analysis of the influence factors of ulcer healing Through the single factor analysis,pathological position,pathologic type and initial ulcer area have an impact on ESD ulcer healing after operation(P < 0.05).Further multi-factor stepwise Logistic regression analysis showed that the initial ulcer area and the pathological positions were associated with a significant ESD ulcer healing after operation(P < 0.01).Conclusions:The comparison of the endoscopic ulcer area and surgical specimen area shows that they were positively correlated,correlation coefficient r is 0.978,as the significant correlation.EAS method can be used to measure the lesions area in vivo,as a certain feasibility and accuracy.ESD is reliable and effective means in the treatment of digestive tract precancerous lesions and EGC.The area of ESD postoperative iatrogenic ulcer is larger,it is necessary to promote ulcer healing,prevent the happening of the complications such as hemorrhage,perforation.Our research adopts the different medical methods to terat ESD postoperative iatrogenic ulcers and observe the rate and quality of ulcer healing after ESD,results show that PPI with mucosa protectant therapy is superior to the PPI therapy alone,suggest that PPI joint mucosal protective agent can effectively promote ulcer healing,reduce the incidence of postoperative complications.using the method of EAS to measure the postoperative ulcer area accuratelly is conductive to assess the ulcer healing and evaluate the effect of drug treatment.