A201 EFFICACY OF PROTON PUMP INHIBITOR PLUS MUCOPROTECTIVE AGENT FOR ENDOSCOPIC SUBMUCOSAL DISSECTION-DERIVED ULCER; A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROL TRIAL
Bibliographic record
Abstract
Currently, it is still unclear whether adding a mucoprotective agent to a Proton Pump Inhibitor (PPI) (combination treatment) results in better outcomes compared to using a PPI alone, in term of both ulcer healing and delayed bleeding in patients with post gastric-endoscopic submucosal dissection (ESD) ulcers. We conducted a meta-analysis of randomized control trials examining the efficacy of PPI alone versus combination treatment in post gastric-ESD ulcer healing as well as delayed bleeding. We performed a systematic search of MEDLINE, EMBASE, Cochrane, and ISI Web of knowledge databases, up until May 2017, for randomized trials (RCTs) comparing PPI alone versus PPI plus a mucoprotective drug in achieving ulcer healing in patients undergoing gastric ESD. Medical subject headings and keywords included PPI (omeprazole, esomeprazole, lansoprazole, dexlansoprazole, pantoprazole and rabeprazole) and mucoprotective agents (rebamipide and sucralfate). Pediatrics trials, non human subjects, not fully published articles or non-English publications were excluded. The primary outcome is scaring stage (S1 or S2) on endoscopic assessment at 4 weeks or 8 weeks after gastric ESD. Preplanned subgroup and sensitivity analyses were performed. A meta-analysis was conducted using random effect models with results reported as risk-ratios (RR) with 95% confidence intervals. Heterogeneity and publication bias were assessed and quantified. From an initial 2250 citations, seven articles with 897 patients were analysed. Various PPI molecules were studied, but rebamipide was the only mucoprotective agent used in all studies. Up to 4 or 8 weeks after ESD, patients receiving combination treatment achieved a greater scaring stage significantly more often than PPIs alone (RR=1.4, 95% CI; 1.02–1.94 with heterogeneity: I2 = 76%). There were no significant between treatment-group differences in term of delayed bleeding (RR= 0.64, 95% CI; 0.17–2.44). In sub-group analysis, no differences were noted in scaring stage between combination treatment and PPI alone at either 4 (RR=1.51, 95% CI; 1.00–2.27) or 8 weeks (RR=1.12, 95% CI; 0.78–1.62) follow-up when analyzing separately. Neither location of ulcer nor H.pylori infection were related to ulcer scaring stage whether the patients received combination treatment or PPI alone. Combination therapy was more effective than PPI alone in achieving rapid post–ESD ulcer healing amongst studies published before 2014 (RR=1.74, 95% CI; 1.39- 2.20). In contrast, no differences were noted amongst more recent studies (RR=0.92, 95% CI; 0.77–1.09). Combination treatment may be more effective in accelerating the process of ulcer healing in patients undergoing gastric ESD than the use of PPI alone, but does not alter delayed bleeding risk. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.043 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.025 | 0.040 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".