Factors influencing development of pain after gastric endoscopic submucosal dissection: a randomized controlled trial

Background and study aims: Endoscopic submucosal dissection (ESD) is widely used for local treatment of gastric neoplasms. Although ESD-related complications such as bleeding and perforation have been reported, data are currently lacking on the development of pain, which is one of the most common adverse events after ESD. The aim of the current study was to investigate the incidence and clinicopathologic risk factors of pain after ESD.

Patients and methods: A prospective randomized controlled study was conducted to evaluate 156 patients with gastric neoplasms treated by ESD at Gangnam Severance Hospital between April 2011 and August 2013. All patients were randomly assigned to treatment with intravenous proton pump inhibitor (PPI) either before or after ESD. Acid infusion tests were performed in a subgroup of 21 patients to investigate the mechanism of pain after ESD.

Results: The incidence of moderate-to-severe pain after ESD was significantly lower in the group that received preprocedure PPI (44.9 %) compared to those who did not (62.8 %). Female sex, tumors of the distal stomach (i. e. lower third), baseline dyspeptic symptoms, and positive acid infusion testing were variables that correlated significantly with the development of pain after ESD, although female sex was not significant in multivariate analysis.

Conclusions: Patients with tumors of the distal stomach and baseline dyspeptic symptoms were more likely to develop pain after gastric ESD. Hypersensitivity to acid was one mechanism fueling post-ESD pain. Prophylactic PPI treatment was effective at reducing post-ESD pain.

Trial registered at Clinicaltrials.gov (NCT02254889).

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