Prevention of delayed bleeding with vonoprazan in upper gastrointestinal endoscopic treatment

[Backgrounds] Delayed bleeding is the major adverse event in upper gastrointestinal endoscopic treatment (UGET).Vonoprazan is a novel agent with stronger acid-inhibitory activity than proton pump inhibitor (PPI). We aimed to clarify whether vonoprazan is beneficial for reducing delayed bleeding risk in UGET. [Methods] This study used the Diagnosis Procedure Combination database in Japan. We included patients on vonoprazan or PPI in UGET between 2014 and 2019. UGET consisted of seven procedures including esophageal endoscopic submucosal dissection (E-ESD) and gastroduodenal endoscopic submucosal dissection (GD-ESD). The primary outcome was delayed bleeding. We conducted propensity score matching using 24 variables to balance the comparison groups, and logistic regression analyses to compare the bleeding outcomes. [Results] We enrolled 124,422 patients, in which 34,822 and 89,600 were prescribed with vonoprazan and PPI, respectively. After propensity score matching, the risk for delayed bleeding was lower in vonoprazan than in PPI (odds ratio, 0.75 [95% confidence interval, 0.71–0.80]). In the subgroup analyses of seven UGET procedures, vonoprazan was significantly advantageous in E-ESD (0.71 [0.54–0.94]) and GD-ESD (0.70 [0.65–0.75]); however, the nominal significance of vonoprazan in E-ESD was removed by Bonferroni correction. [Conclusions] This study found that, compared with PPI, vonoprazan can reduce delayed bleeding with approximately 30% in GD-ESD. Vonoprazan has the possibility to become a new treatment method for preventing delayed bleeding in this procedure.