Time-dependent efficacy of seven pharmacological regimens for ulcer healing and delayed bleeding prevention after gastric endoscopic submucosal dissection: A frequentist network meta-analysis.
Linqiang Li, Xiaowei Zhu, Hengda Hu
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In 30 seconds
This frequentist network meta-analysis compared seven pharmacological regimens for ulcer healing and prevention of delayed bleeding or perforation after gastric endoscopic submucosal dissection. It included 31 randomized controlled trials, with healing assessed at 4 and 8 weeks. At 4 weeks, P-CAB monotherapy had the highest numerical P-score ranking, but its estimated advantage over PPI was not statistically significant (OR=1.61, 95%CI 0.96-2.68, P = 0.069). No regimen showed statistically significant superiority for ulcer healing, and complication risks were comparable across regimens.
Key findings
- At 4 weeks, P-CAB monotherapy favored PPI numerically (OR=1.61, 95%CI 0.96-2.68, P = 0.069), without a statistically significant difference.
- P-CAB ranked highest numerically for 4-week healing; PPI + MP ranked highest numerically at 8 weeks, but no regimen was significantly superior to PPI.
- Delayed bleeding and perforation risks were comparable across regimens; H2RA-based treatments showed a non-significant trend toward higher complication risk.
- Most pairwise comparisons had low-to-moderate certainty evidence.
Why it matters
Post-ESD mucosal defects can lead to delayed complications, and this analysis compares commonly used pharmacological strategies for healing and risk reduction. Its findings indicate that numerical rankings should not be interpreted as established superiority: the evidence did not identify a regimen with significantly better healing or fewer complications, and certainty was often limited.
What to keep in mind
Most pairwise comparisons were supported by low-to-moderate certainty evidence, limiting confidence in comparative estimates.