The Effect of Tegoprazan for Prevention of Iatrogenic Ulcer Bleeding after Endoscopic Submucosal Dissection: A Noninferiority Randomized Clinical Trial
- Journal
- Gut and liver (Q1)
- Published
- 24 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Joon Sung Kim, Byung-Wook Kim, Kwang Bum Cho, Jae Young Jang, Hyuk Soon Choi, Gwang Ho Baik, et al.
- PMID
- 42494366
- DOI
- 10.5009/gnl260117
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 25 July 2026).
Abstract
BACKGROUND/AIMS: Proton pump inhibitors (PPIs) effectively reduce bleeding in patients after endoscopic submucosal dissection (ESD). Tegoprazan, a potassium-competitive acid blocker, provides stronger acid suppression than PPIs do; however, its efficacy in preventing post-ESD bleeding has rarely been studied. The aim of this study was to compare the effects of tegoprazan and pantoprazole on post-ESD bleeding. METHODS: In this randomized, multicenter trial, patients undergoing ESD for gastric epithelial neoplasms were randomly assigned to two groups; each received tegoprazan (50 mg once daily for 28 days) or pantoprazole (40 mg intravenously for 48 hours and orally once daily for 26 days). Adverse events and serum gastrin levels were assessed as safety outcomes. RESULTS: The per-protocol set comprised 238 patients (117 tegoprazan, 121 pantoprazole). Noninferiority (within an 8.3% margin) in the post-ESD bleeding rates within 4 weeks was confirmed (risk difference, -6.30%; 95% confidence interval [CI], -14.67% to 2.07%; p=0.0003), with rates of 9.40% (11/117) and 15.70% (19/121) for the tegoprazan and pantoprazole groups, respectively. The bleeding rates within 24 hours were 5.98% (7/117) and 10.74% (13/121), respectively (risk difference, -4.76%; 95% CI, -11.75% to 2.23%). No significant differences were observed in adverse events or serum gastrin levels between the groups. CONCLUSIONS: Tegoprazan was non-inferior to pantoprazole in its effectiveness in preventing post-ESD bleeding, with comparable safety profiles. Notably, administering oral tegoprazan can potentially shorten the length of hospital stay and reduce medical costs, supporting its potential clinical value. Tegoprazan is expected to replace high-dose intravenous PPI therapy for patients after ESD (CRIS registration: KCT0006850).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.