Effect of oral proton pump inhibitor administration on reducing the delayed bleeding risk in five upper gastrointestinal endoscopic treatments

Objective: Although proton pump inhibitor (PPI) is often prescribed for reducing delayed bleeding in upper gastrointestinal endoscopic treatments, no studies with a sufficient sample size evaluated its reduced effect compared with absence of acid-suppressive agents. This study aimed to investigate the effect of oral PPI on reducing delayed bleeding in five upper gastrointestinal endoscopic treatments. Methods: This population-based cohort study collected data from patients who were either prescribed with PPIs or received no acid-suppressive therapy and who underwent esophageal endoscopic mucosal resection (E-EMR), esophageal endoscopic submucosal dissection (E-ESD), gastric endoscopic mucosal resection (G-EMR), gastric endoscopic submucosal dissection (G-ESD), or percutaneous endoscopic gastrostomy (PEG) in Japan between 2012 and 2022 from the Diagnosis Procedure Combination database. The primary outcome was delayed bleeding in each procedure. We conducted propensity score matching (PSM) to balance two comparison groups and performed logistic regression analyses to compare bleeding outcomes. Results: This study included data on 172,635 patients. After PSM, the delayed bleeding risk with PPI use was significantly lower in G-EMR (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.52–0.84) and G-ESD (OR, 0.39; 95% CI, 0.30–0.50). In contrast, a lower delayed bleeding risk of PPI was not observed in E-EMR (OR, 1.05; 95% CI, 0.56-1.99), E-ESD (OR, 1.09; 95% CI, 0.86–1.38), and PEG (OR, 1.03; 95% CI, 0.93–1.13). The subgroup and sensitivity analyses almost consistently confirmed the main results. Conclusions: Oral PPI administration contributed to reducing delayed bleeding risk in G-EMR and G-ESD, but not in E-EMR, E-ESD, and PEG.