Late Delayed Bleeding After Gastric ESD with Esomeprazole/Sodium Bicarbonate Versus Conventional Esomeprazole, and Artificial Ulcer Healing with Esomeprazole/Sodium Bicarbonate: A Retrospective Cohort Study
- 1Department of Internal Medicine, Dong-Eui Medical Center, Busan 47227, Republic of Korea
- 2Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
Abstract
Background/Objectives: Artificial ulcers after gastric endoscopic submucosal dissection (ESD) generally heal within 8 weeks with proton pump inhibitor (PPI) therapy; however, delayed bleeding remains a clinically relevant complication. Esomeprazole/sodium bicarbonate is an immediate-release PPI formulation; its role after ESD is unclear. Methods: This single-center retrospective study included 923 patients who underwent gastric ESD from July 2017 through December 2025. Late delayed bleeding, defined as bleeding after second-look endoscopy, was compared between patients receiving esomeprazole/sodium bicarbonate (n = 532) and conventional esomeprazole (n = 391) using Firth logistic regression adjusted for calendar period and clinical factors. Eight-week artificial ulcer healing was assessed descriptively only in the esomeprazole/sodium bicarbonate group (n = 527). Results: Late delayed bleeding occurred in 26/923 patients (2.8%): 16/532 (3.0%) in the esomeprazole/sodium bicarbonate group and 10/391 (2.6%) in the conventional esomeprazole group. PPI formulation was not associated with late delayed bleeding (adjusted OR 0.872; 95% CI 0.313–2.427). Submucosal fibrosis (adjusted OR 4.502; 95% CI 1.969–10.292), antiplatelet use (adjusted OR 3.620; 95% CI 1.617–8.103), and anticoagulant use (adjusted OR 6.783; 95% CI 1.323–34.770) were independently associated with bleeding. All 26 patients with bleeding were men; sex was therefore excluded from the model. Complete healing was observed in 510/527 patients (96.8%); ulcer diameter ≥ 40 mm was independently associated with incomplete healing (adjusted OR 7.114; 95% CI 2.664–18.998). Conclusions: No statistically significant difference in late delayed bleeding was detected between formulations, although a clinically meaningful difference cannot be excluded. Healing was assessed only in the esomeprazole/sodium bicarbonate group and could not be compared between formulations. Late delayed bleeding was associated with submucosal fibrosis and antithrombotic therapy.
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BibTeX
@article{nam2026late,
title = {{Late Delayed Bleeding After Gastric ESD with Esomeprazole/Sodium Bicarbonate Versus Conventional Esomeprazole, and Artificial Ulcer Healing with Esomeprazole/Sodium Bicarbonate: A Retrospective Cohort Study}},
author = {Hyeong-Seok Nam and Dae-Gon Ryu and Su-Jin Kim and Su-Bum Park and Jin-Ook Jang and Woo-Jin Kim and Cheol-Min Lee and Eun-Jung Choi and Cheol-Woong Choi},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218454},
url = {https://www.mdpi.com/2077-0383/15/21/8454},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Late Delayed Bleeding After Gastric ESD with Esomeprazole/Sodium Bicarbonate Versus Conventional Esomeprazole, and Artificial Ulcer Healing with Esomeprazole/Sodium Bicarbonate: A Retrospective Cohort Study
AU - Hyeong-Seok Nam
AU - Dae-Gon Ryu
AU - Su-Jin Kim
AU - Su-Bum Park
AU - Jin-Ook Jang
AU - Woo-Jin Kim
AU - Cheol-Min Lee
AU - Eun-Jung Choi
AU - Cheol-Woong Choi
PY - 2026
DA - 2026/10/30
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218454
UR - https://www.mdpi.com/2077-0383/15/21/8454
AB - Background/Objectives: Artificial ulcers after gastric endoscopic submucosal dissection (ESD) generally heal within 8 weeks with proton pump inhibitor (PPI) therapy; however, delayed bleeding remains a clinically relevant complication. Esomeprazole/sodium bicarbonate is an immediate-release PPI formulation; its role after ESD is unclear. Methods: This single-center retrospective study included 923 patients who underwent gastric ESD from July 2017 through December 2025. Late delayed bleeding, defined as bleeding after second-look endoscopy, was compared between patients receiving esomeprazole/sodium bicarbonate (n = 532) and conventional esomeprazole (n = 391) using Firth logistic regression adjusted for calendar period and clinical factors. Eight-week artificial ulcer healing was assessed descriptively only in the esomeprazole/sodium bicarbonate group (n = 527). Results: Late delayed bleeding occurred in 26/923 patients (2.8%): 16/532 (3.0%) in the esomeprazole/sodium bicarbonate group and 10/391 (2.6%) in the conventional esomeprazole group. PPI formulation was not associated with late delayed bleeding (adjusted OR 0.872; 95% CI 0.313–2.427). Submucosal fibrosis (adjusted OR 4.502; 95% CI 1.969–10.292), antiplatelet use (adjusted OR 3.620; 95% CI 1.617–8.103), and anticoagulant use (adjusted OR 6.783; 95% CI 1.323–34.770) were independently associated with bleeding. All 26 patients with bleeding were men; sex was therefore excluded from the model. Complete healing was observed in 510/527 patients (96.8%); ulcer diameter ≥ 40 mm was independently associated with incomplete healing (adjusted OR 7.114; 95% CI 2.664–18.998). Conclusions: No statistically significant difference in late delayed bleeding was detected between formulations, although a clinically meaningful difference cannot be excluded. Healing was assessed only in the esomeprazole/sodium bicarbonate group and could not be compared between formulations. Late delayed bleeding was associated with submucosal fibrosis and antithrombotic therapy.
SN - 2077-0383
ER -