Risk Factors Of Delayed Gastric Ulcer Healing After Endoscopic Resection

Part 1 Gastric ulcer healing after endoscopic resection:an observation cohort studyObjective:To evaluate risk factors of delayed ulcer healing after gastric endoscopic resection.Methods:We follow-up visited 175 patients who had gastric endoscopic resection for gastric neoplasms between February 2010 to August 2015, and recorded their clinical information such as age.sex, comorbidity disease (diabetes mellitus), ulcer size, ressection method, ulcer location, H.p status et al. After 8 weeks’treatment,we made another endoscopy to evaluate the ulcers’stage, patients were than allocated to healing group or nonhealing group. Univariate analysis and multivariate analysis were made to assess the possible risk factors.Results:A total of 153 patients with 166 ulcers were finally enrolled, and the healing rate was 82.5%(137/166). In univariate analysis, sex, size more than 3 cm, pathology and suturing status are possible risk factors for delayed ulcer healing(all with P<0.05). In multivariate analysis, size more than 3 cm (OR:2.754; 95%CI:1.086～6.984; P: 0.033) was an independent risk factors affecting ulcer’s healing, and suturing up with matal clips (OR:0.296; 95%CI:0.101-0.871; P:0.027) could facilitate ulcer’s healing. Subanalysis of ulcers without suturing showed that damage of muscle layer (P:0.011; 95%CI:1.730,71.106; OR:11.091) was another independent risk factor associated with delayed ulcer healing. Meanwhile, Helicobactor pylori infection was not related to delayed ulcer healing (P>0.05)Conclusions:Size more than 3 cm and damage of muscle layer were two independent factors of delayed ulcer healing after gastric endoscopic ressection. Suturing up with matal clips accelarates ulcer healing.Part 2 Risk factors of delayed gastric ulcer healing after endoscopic resection:a meta analysisObjective:The objective of this meta-analysis was to systematically assess the possible risk factors of ulcer after gastric endoscopic resection.Methods:Relevant studies were identified through searching PubMed, Web of Science, Cochrane databases, Em base, CNKI, VIP and Wangfang data before April 2016. Two investigators extracted data independently for baseline characteristics and outcomes from the included studies. Either a fixed-effects or a random-effects model was derived to composite the pooled OR for possible risk factors.Results:Seventeen studies were finally included in this meta-analysis. The composition results indicated that large initial ulcer size (OR:3.02; 95%CI:1.44～6.31), damage of proper muscle (OR:4.58;95%CI:2.34～8.97), male patients (OR:1.39;95%CI: 1.03～1.87)、helicobacter pylori infection(OR:1.11;95%CI:1.07～1.14),concomitant diabetes mellitus (OR:1.68;95%CI:1.05-2.69) and long procedure time (OR: 2.32; 95%CI:1.22～4.40) were significantly associated with delayed ulcer healing. Whereas, the composition results of adjusted OR indicated that just large initial ulcer size (OR:3.02; 95%CI:1.44～6.31), damage of proper muscle (OR:4.58; 95%CI: 2.34-8.97)and male patients (OR:2.26; 95%CI:1.13-4.54)were were significantly associated with delayed ulcer healing. We observed no evidence of an association between proton pump inhibitor use less than 8 week’s standard dose and delayed ulcer healing. Early gastric cancer and ulcer’s location were also not associated with delayed ulcer healing.Conclusions:Large initial ulcer size, damage of proper muscle layer, male patients are risk factors of delayed ulcer healing; Helicobactor pylori infection may associate with delayed ulcer healing which needs further studies due to insufficient adjusted OR.