{
  "abstract": "Background: Gastric ESD induces large mucosal defects with potential delayed complications, including bleeding and perforation. The comparative efficacy of pharmacological regimens—PPI, P-CAB, H2RA, MP, and their combinations—remains unclear. Methods: We conducted a frequentist network meta-analysis of 31 randomized controlled trials evaluating seven pharmacological strategies for post-ESD ulcer healing and delayed bleeding prevention. Outcomes were assessed at 4 and 8 weeks for mucosal healing and ulcer reduction, and across the treatment course for delayed bleeding/perforation. Odds ratios (ORs), mean differences (MDs), and P-scores were calculated. Heterogeneity, inconsistency, sensitivity, and publication bias were assessed. Transitivity was evaluated qualitatively, and certainty of evidence was rated using the GRADE framework. Results: At 4 weeks, the point estimate for P-CAB monotherapy favored PPI (OR=1.61, 95%CI 0.96–2.68, P = 0.069), but the confidence interval included the null value and the difference was not statistically significant; P-CAB had the highest numerical P-score ranking; combination regimens (PPI + MP, P-CAB + MP) also yielded numerically better healing outcomes. At 8 weeks, PPI + MP had the highest numerical P-score ranking, though no regimen achieved statistically superior healing compared with PPI. For delayed bleeding and perforation, all regimens demonstrated comparable safety profiles, while H2RA-based treatments showed a non-significant trend toward higher complication risk. Most pairwise comparisons were supported by low-to-moderate certainty evidence. Conclusions: While P-CAB-based regimens and MP combinations showed numerically favorable trends for early post-ESD ulcer healing, all comparative findings are limited by mostly low-to-moderate GRADE evidence certainty, and no regimen exhibited statistically significant superiority for ulcer healing. No regimen significantly reduces delayed bleeding or perforation risk.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Gastroenterology, Tongxiang Hospital of Traditional Chinese Medicine, Tongxiang City, Zhejiang Province, China.",
    "Department of Urology, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of Shanghai Sixth People's Hospital, Jinshan District, Shanghai, China."
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Linqiang Li",
      "orcid": "0000-0001-5261-9022"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaowei Zhu"
    },
    {
      "affs": [
        1
      ],
      "name": "Hengda Hu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/15pmvjfp6kmph.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0362119",
  "fulltext_url": "https://europepmc.org/articles/PMC13750581",
  "id": "15pmvjfp6kmph",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0362119",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "plos",
      "/Biology and life sciences/Physiology/Physiological processes/Tissue repair/Wound healing"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Hemorrhage"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Ulcers"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Medical risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Endoscopy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Vascular medicine/Hemorrhage"
    ],
    [
      "plos",
      "/People and places/Geographical locations/Asia/Japan"
    ],
    [
      "plos",
      "/Physical sciences/Mathematics/Statistics/Statistical methods/Metaanalysis"
    ],
    [
      "plos",
      "/Research and analysis methods/Mathematical and statistical techniques/Statistical methods/Metaanalysis"
    ],
    [
      "plos",
      "/Science policy/Research integrity/Publication ethics"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://europepmc.org/articles/PMC13750581?pdf=render",
  "pmcid": "PMC13750581",
  "pmid": "43008008",
  "published": "2026-11-10",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/15pmvjfp6kmph.ris",
  "sources": [
    {
      "first_seen": "2026-11-11T12:21:00Z",
      "native_id": "10.1371/journal.pone.0362119",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0362119"
    },
    {
      "first_seen": "2026-11-12T15:21:47Z",
      "native_id": "MED:43008008",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/43008008"
    }
  ],
  "subjects": [
    {
      "field": "mathematics",
      "origin": "plos:statistical methods",
      "subfield": "statistics"
    },
    {
      "field": "medicine",
      "origin": "plos:epidemiology",
      "subfield": "epidemiology-public-health"
    },
    {
      "field": "medicine",
      "origin": "plos:physiology",
      "subfield": "physiology"
    }
  ],
  "title": "Time-dependent efficacy of seven pharmacological regimens for ulcer healing and delayed bleeding prevention after gastric endoscopic submucosal dissection: A frequentist network meta-analysis",
  "title_text": "Time-dependent efficacy of seven pharmacological regimens for ulcer healing and delayed bleeding prevention after gastric endoscopic submucosal dissection: A frequentist network meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T03:20:44Z",
  "url": "https://research.draconitic.com/paper/15pmvjfp6kmph",
  "venue": "PLOS One",
  "versions": []
}