The use of PPI’s can be helpful in clinical practice to prevent post-endoscopic submucosal dissection (ESD) gastric bleeding and decrease the concerning costs. This study also found a similar tendency in ulcer healing following ESD in low-dose PPIs and high dose PPIs.

This multicenter, non-inferiority, randomized controlled trial aimed to examine the intermittent use of low-dose PPI to prevent gastric bleeding after ESD.

The patients diagnosed with gastric mucosal lesions following the ESD therapy (526 patients) were randomly allocated to either occasional low-dose (209 patients) or continuous high-dose (205 patients) PPIs treatment. After 3 days, all patients were given esomeprazole oral at 40 mg dose QD for 8 weeks. Post-ESD bleeding within a week was regarded as the primary endpoint. Intention-to-treat analysis with the non-inferiority margin (Δ) of 5% was considered.

The number of patients with post-ESD bleeding in Low-dose PPI group were found to be 13 out of 209 and High-dose PPI group were 12 out of 205 patients in a week.

Absolute risk reduction was found to be 0.4 %. The low-dose and high-dose group had 44 patients (21.1 %) and 39 patients (19.0 %) in scar stage, a month following ESD. Low-dose PPI group had lower hospital costs in comparison with high-dose group.

Post-ESD bleeding can be prevented with the intermittent use of low-dose PPIs.