Safer endoscopic gastric mucosal resection: preoperative proton pump inhibitor administration.

Background and Aim:  Control of bleeding is crucial in improving the safety of endoscopic mucosal resection (EMR), and intragastric acidity has a great impact on hemostasis and blood coagulation. Proton pump inhibitors (PPI) are potent suppressors of gastric acid; however, PPI need to be continuously administered orally for several days, and thus initial effects may be insufficient if PPI is only administered immediately after EMR. The aim of this study was to determine whether preoperative administration of PPI prior to EMR can elevate intragastric acidity, facilitate better control of intraoperative bleeding (complete coagulation and hemostasis), prevent postoperative bleeding, and facilitate healing of artificial ulcers. Methods:  A randomized clinical study was conducted in which EMR was performed with or without 1 week of preoperative PPI administration. Results:  Artificial ulcers created by EMR healed more rapidly in patients who received preoperative PPI. Conclusions:  The results of the study suggest that preoperative administration of PPI before EMR is useful for controlling and preventing bleeding, and for facilitating the healing of artificial ulcers.