Vonoprazan vs lansoprazole for the treatment of endoscopic submucosal dissection induced gastric ulcer: a systematic review and meta-analysis

Background: vonoprazan is a potassium competitive acid blocker (P-CAB) approved in Japan in 2014 to treat endoscopic submucosal dissection (ESD)-induced ulcers and bleeding or perforation. Therefore, this meta-analysis aimed to determine whether vonoprazan is more effective than lansoprazole in the treatment of ESD-induced ulcers which include ulcer healing and shrinking rate, among others. Methods: randomized controlled trials (RCT) and retrospective studies were collected from the PubMed (Medline), Embase, Web of Science and Cochrane Library databases. Meanwhile, studies were selected according to predetermined qualification criteria and data were extracted by two researchers. The quality of the methods for published papers was evaluated using the modified Jadad scale. Results: five studies were included in this meta-analysis. The ulcer healing rate effect was not significantly higher in the intervention groups than in the control groups at four weeks (OR: 1.07 [0.51, 2.22], 95 % CI, I-2 = 2 %, Z = 0.18, p = 0.86). There was no significant difference in the ulcer shrinkage rate at four weeks (MD: 0.20 [-1.51, 1.92], 95 % CI, I-2 = 0 %, p = 0.82) and eight weeks (MD: -0.09 [-0.30, 0.12], 95 % CI, I-2 = 0 %, p = 0.39). Conclusion: there was no significant difference between vonoprazan and lansoprazole in the ulcers induced by treatment after four weeks and eight weeks of treatment with ESD.