Comparison of Potassium-Competitive Acid Blockers and Proton Pump Inhibitors in Preventing Delayed Bleeding after Endoscopic Submucosal Dissection of Early Gastric Cancer: An Update Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Abstract Background: Proton pump inhibitors (PPIs) and potassium-competitive acid blocker (PCAB) are two different drugs that may be used after upper gastrointestinal endoscopic submucosal dissection (ESD). However, whether PCAB can reduce postoperative complications more than PPIs is a matter of controversy.Methods: We searched studies that reported the effectiveness of PCAB and PPIs in preventing delayed bleeding after gastric ESD by using PubMed, EMBASE, the Cochrane Library, Web of Science, etc. The Cochrane Risk of Bias Tool and Newcastle Ottawa Quality Assessment Scale were applied to evaluate the quality of the researches. All statistical analyses were carried out using Stata 15.1,including drawing the forest map, subgroup analysis, sensitivity analysis and detection of publication bias.Results: Seventeen studies with 51294 patients were included. There was a statistically difference in the overall delayed bleeding rate between the Vonoprazan group and the PPIs group. The overall mean relative risk (RR) for delayed bleeding following the administration of Vonoprazan was 0.72 (P<0.05) with a 95% confidence interval (CI) (0.67-0.77). However, there was no statistically difference in the incidence of blood transfusion events between the two groups[RR=0.76,95% CI (0.41-1.40)]. There was a statistical difference in the shrinkage ratio between the Vonoprazan group and the PPIs group. The weighted mean difference was 2.68(P<0.05) with a 95% CI (0.44-4.91). The sensitivity analysis showed all results were robust.Conclusions: Compared with PPIs, Vonoprazan showed a better efficacy in reducing the incidence of delayed bleeding and promoting the contraction of artificial ulcers. It might be an appropriate choice that postoperative management of gastric ESD in patients with stomach neoplasms.
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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 | 0.011 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.030 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".