Vonoprazan versus proton pump inhibitors for postendoscopic submucosal dissection bleeding in the stomach: a multicenter population-based comparative study.

Abstract Background and Aims The effectiveness of vonoprazan relative to that of proton pump inhibitors (PPIs) after gastric endoscopic submucosal dissection (ESD) is unclear. Although previous studies used post-ESD ulcer healing as the outcome measure, post-ESD bleeding rate is the most objective and appropriate outcome measure as it has less ascertainment bias. We aimed to compare the post-ESD bleeding rates between vonoprazan and PPIs. Methods This nationwide population-based retrospective cohort study was conducted between 2014 and 2018 and involved nine hospitals. After 2 days of intravenous PPI administration, either vonoprazan or PPI was administrated from postoperative day 2 to day 30. Results Overall, data of 1,715 patients (627 patient pairs) were analyzed through propensity score matching. The vonoprazan group had significantly lower post-ESD bleeding rates than the PPI group (overall: 11.9% vs 17.2%, P=0.008; bleeding between days 2 and 30: 7.8% vs 11.8%, P=0.015). The readmission rate due to post-ESD bleeding was lower in the vonoprazan group (2.4% vs 4.1%, P=0.081). Blood transfusion (2.1% vs 3.0%, P=0.15) and additional surgery due to delayed perforation (0.5 vs 1.0%, P=0.32) were not significantly different between the 2 groups. No deaths within 30 days occurred in both groups. On Cox regression analysis, vonoprazan use, lesion location (antrum), aspirin use, direct oral anticoagulant use, and Charlson Comorbidity Index (≥2) were associated with an increased risk of post-ESD bleeding within 30 days. Conclusions Vonoprazan has a lower post-ESD bleeding rate than PPIs. Further prospective studies are required to confirm these results.