EFFICACY OF REBAMIPIDE IN THE HEALING OF IATROGENIC ULCERS POST ENDOSCOPIC SUBMUCOSAL DISSECTION: A META-ANALYSIS! J Bisnar, MD1, I Cua,MD1! 1Institute of Digestive and Liver Disease, St. Luke’s Medical Center, Quezon City, Philippines!

INTRODUCTION RESULTS The forest plot done for the number of patients who achieved scarring (S) stage after treatment (Figure 2) showed that the use of Endoscopic submucosal dissection (ESD) is a The 6 studies with a total population of 758 were included in the review. rebamipide alone or as an adjunct to a proton pump inhibitor All participants were both male and female patients diagnosed with a treatment option for early gastric cancer (EGC). gastric adenoma or an early gastric cancer who underwent endoscopic compared to placebo (proton pump inhibitor or H2 receptor It is less invasive, however, it is associated with submucosal dissection. 356 patients were randomized to the treatment antagonist) significantly improved healing with a p value of 0.0002. larger, deeper ulcers post-procedure. Combined group. 331 patients received rebamipide as an adjunct to a proton pump Subgroup analysis which included studies that compared use of mucosal protective anti-ulcer drugs such inhibitor and 25 patients received rebamipide monotherapy. Dosage of combination therapy with rebamipide to proton pump inhibitors as rebamipide and proton pump inhibitors (PPI) rebamipide given was a total of 300mg per day. 354 patients were likewise showed significant ulcer healing in the combination group was reported to promote ulcer healing. randomized to the control group. 328 received a proton pump inhibitor with a p value of 0.0002. Another subgroup analysis which only (Lansoprazole 30mg/tab OD, Rabeprazole 20mg/tab OD or included studies that assessed ulcer healing after 4 weeks of OBJECTIVES Pantoprazole 40mg/tab OD) and 26 patients received a H2 receptor antagonist (Famotidine 20mg/tab BID). 1 study assessed the stage of the treatment of rebamipide alone or combination therapy with Determine the efficacy of rebamipide in the post endoscopic submucosal dissection associated ulcer after 8 weeks of rebamipide to placebo (proton pump inhibitor or H2 receptor Figure 4 Subgroup analysis of the ulcer healing rate of Rebamipide in post healing of post ESD associated ulcers treatment while 5 studies assessed the ulcers after 4 weeks. antagonist) showed significant ulcer healing in the treatment group endoscopic submucosal dissection associated ulcers after 4 weeks of treatment The quality of the included 6 studies was assessed using the JADAD with a p value of 0.006. The included studies were homogenous METHODOLOGY scale. 5 of the included studies had a JADAD rating scale of 3 and 1 with an I2 of 0%. A random effects model was adopted to quantify study had a JADAD rating scale of 5. Studies that had a JADAD scale computed outcomes. Publication bias was assessed using a funnel PubMed, Cochrane Database and bibliographies rating of 3 did not describe if the study was double blind or not nor did plot. of retrieved articles were searched for eligible it state the type of blinding done. articles using the keywords: efficacy, rebamipide, iatrogenic ulcers and post endoscopic submucosal dissection. Randomized controlled trials involving patients with EGC who underwent ESD and were given rebamipide monotherapy or as adjunct to PPI were included in this meta-analysis. 2 reviewers extracted the data and assessed the quality of the studies included. A third reviewer resolved any Figure 5 Funnel plot of 6 studies differences in opinion. Review Manager 5 software was used to analyze data from the CONCLUSION studies included. Random effects model was Rebamipide improves the healing of post endoscopic submucosal used for combining quantitative data. dissection associated ulcers especially when administered with Figure 2 Forest plot of ulcer healing rate of Rebamipide in post Figure 3 Subgroup analysis of the ulcer healing rate of Rebamipide in post proton pump inhibitors for 4 weeks. endoscopic submucosal dissection associated ulcers endoscopic submucosal dissection associated ulcers compared to PPIs alone Rembackes et al; “Endoscopic mucosal resection”; Endoscopy; 2001; 33:709-18; Shin et al;“Can rebamipide Copyright © 2014 Bisnar, Jo-Anne, [email protected]; and proton pump inhibitor combination therapy promote the healing of endoscopic submucosal dissection- The authors of this poster are not supported by any pharmacological company. induced ulcers? A randomized, prospective, multicenter study”; Gastrointestinal Endoscopy 2012; Vol 75; No. Cua, Ian Homer, [email protected] 4; 739-747.