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Proton Pump Inhibitor Therapy before and after Endoscopic Submucosal Dissection: A Review

机译：内镜黏膜下剥离术前后质子泵抑制剂治疗的回顾

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Endoscopic submucosal dissection (ESD) is a novel endoscopic procedure first developed in the 1990s which enables en bloc resection of gastric neoplastic lesions that are difficult to resect via conventional endoscopic mucosal resection. However, given that ESD increases the risk of intra- and post-ESD delayed bleeding and that platelet aggregation and coagulation in artificial ulcers after ESD strongly depend on intragastric pH, faster and stronger acid inhibition via proton pump inhibitors (PPIs) and histamine 2-receptor antagonists (H2RAs) as well as endoscopic hemostasis by thermocoagulation during ESD have been used to prevent ESD-related bleeding. Because PPIs more potently inhibit acid secretion than H2RAs, they are often the first-line drugs employed in ESD treatment. However, acid inhibition after the initial infusion of a PPI is weaker in the early phase than that achievable with H2RAs; further, PPI effectiveness can vary depending on genetic differences in CYP2C19. Therefore, optimal acid inhibition may require tailored treatment based on CYP2C19 genotype when ESD is performed, with a concomitant infusion of PPI and H2RA possibly most effective for patients with the rapid metabolizer CYP2C19 genotype, while PPI alone may be sufficient for those with the intermediate or poor metabolizer genotypes.
机译：内窥镜黏膜下剥离术（ESD）是一种新型的内窥镜手术方法，最早于1990年代开发，它可以整体切除难以通过常规内窥镜黏膜切除术切除的胃肿瘤性病变。但是，鉴于ESD增加了ESD内和ESD后延迟出血的风险，并且ESD后人造溃疡中的血小板聚集和凝结强烈依赖于胃内pH值，因此通过质子泵抑制剂（PPI）和组胺2可以更快，更强地抑制酸ESD受体拮抗剂（H2RAs）以及在ESD期间通过热凝术进行内镜止血已被用于预防ESD相关的出血。由于PPI比H2RA更有效地抑制酸分泌，因此它们通常是ESD治疗中使用的一线药物。然而，最初输注PPI后的酸抑制作用在早期比H2RAs弱。此外，PPI的有效性可能会因CYP2C19的遗传差异而异。因此，进行ESD时，最佳的酸抑制可能需要根据CYP2C19基因型进行量身定制的治疗，同时注入PPI和H2RA对快速代谢者CYP2C19基因型的患者可能最有效，而单独使用PPI可能对于中等或中等代谢者就足够了不良的代谢者基因型。

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