Comparison of vonoprazan and proton pump inhibitors for the management of gastric post-endoscopic submucosal dissection ulcers and preventing delayed bleeding: a meta-analysis of randomized controlled trials
In brief
Vonoprazan cut delayed bleeding about half after endoscopic stomach lesion removal
In 11 randomized trials involving 1,136 patients after gastric endoscopic submucosal dissection, delayed bleeding occurred in 2.8% taking vonoprazan versus 5.8% taking proton pump inhibitors. Ulcer healing was similar, and adverse events were less frequent with vonoprazan; the bleeding result is based on few events, so its size remains uncertain.
- Journal
- Frontiers in medicine (Q1)
- Published
- 11 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Nan Lin, Jianxiong Liu, Changqing Yang
- PMID
- 42798450
- DOI
- 10.3389/fmed.2026.1936609
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 27 September 2026).
Abstract
BACKGROUND: Delayed bleeding and artificial-ulcer healing are important clinical concerns after gastric endoscopic submucosal dissection (ESD). Vonoprazan rapidly suppresses gastric acid, but its efficacy relative to proton pump inhibitors (PPIs) remains uncertain. METHODS: We searched seven databases from inception to May 31, 2026. Randomized controlled trials (RCTs) comparing vonoprazan with PPIs after gastric ESD were included. Outcomes were pooled as relative risks (RRs) or mean differences (MDs), with 95% confidence intervals (CIs). RESULTS: Eleven RCTs reported delayed-bleeding data for 1,136 participants (580 receiving vonoprazan and 556 receiving a PPI). Delayed bleeding occurred in 16/580 (2.76%) vs. 32/556 (5.76%) participants (RR = 0.51, 95% CI 0.29-0.89; P = 0.02). Nine trials contributed to the relative-effect estimate because two reported zero events in both arms; a risk-difference sensitivity analysis including all 11 trials supported the result. Ulcer healing rates did not differ at 4 weeks (RR = 0.93, 95% CI 0.65-1.33; P = 0.69) or 8 weeks (RR = 0.98, 95% CI 0.92-1.04; P = 0.49). Ulcer shrinkage rates also did not differ at 4 weeks (MD = -0.89, 95% CI -2.10 to 0.33; P = 0.15) or 8 weeks (MD = 0.45, 95% CI -0.27 to 1.16; P = 0.22). Adverse events were less frequent with vonoprazan (RR = 0.57, 95% CI 0.34-0.98; P = 0.04). CONCLUSION: Vonoprazan may reduce delayed bleeding and adverse events after gastric ESD while achieving ulcer healing and shrinkage comparable to PPIs; the bleeding estimate is based on few events and should be interpreted cautiously. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261424595, CRD420261424595.
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.