Vonoprazan vs. Esomeprazole: Scarring Rate of Post-endoscopic Submucosal Dissection Ulcers in the Postoperative Stomach

Objective Proton pump inhibitors (PPIs) are ineffective in suppressing gastric acid secretion after prolonged exposure to an acidic environment in the stomach. In this study, we compared vonoprazan (VPZ) and PPI esomeprazole (EPZ) according to the rate of ulcer scarring after gastric endoscopic submucosal dissection (ESD) in the postoperative stomach, where food residues are often observed, and we investigated their effectiveness in clinical practice. Methods We compared 56 lesions treated with VPZ (20 mg) and 52 lesions treated with EPZ (20 mg) in the postoperative stomach and retrospectively evaluated the scarring rate of post-ESD ulcers at 8 weeks. ESD was performed in our hospital between January 2011 and May 2023. Results The post-ESD ulcer scarring rate after eight weeks was significantly higher in the VPZ group than in the EPZ group (83.9% vs. 57.7%, p<0.01). In the respective groups, the mean age was 72.8 and 70.8 years, food residual rate were 41.1% and 30.8%, the mean resection area was 770.0 and 1,282.4 mm² (p<0.05), and the postoperative bleeding rates were 5.4% and 7.7%, respectively. There were no significant differences in sex, surgical procedure, diabetes status, or use of steroids, nonsteroidal anti-inflammatory drugs, or antithrombotic medications. An analysis using propensity scores to adjust for age, sex, surgical procedure, and resection area showed a significantly higher scarring rate in the VPZ group (odds ratio 2.65, p<0.05). Conclusion VPZ was associated with a significantly higher scarring rate for post-ESD ulcers in the postoperative stomach than EPZ.