Healing and Management of Endoscopic Submucosal Dissectioninduced Artificial Ulcers: Evidence and Advances
10.52927/jdcr.2026.14.1.12
- Author:
Hyun LIM
1
Author Information
1. Department of Gastroenterology, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
- Publication Type:REVIEW ARTICLE
- From:
Journal of Digestive Cancer Research
2026;14(1):12-19
- CountryRepublic of Korea
- Language:English
-
Abstract:
Endoscopic submucosal dissection (ESD) has become the standard treatment for early gastric neoplasms owing to its high en bloc resection rate and low recurrence. However, ESD inevitably creates large artificial ulcers, which differ markedly from conventional peptic ulcers in etiology, morphology, and healing behavior. Post-ESD ulcers develop rapidly through thermal injury, leaving extensive mucosal and submucosal defects while preserving the muscularis propria.Healing is characterized by early ulcer contraction followed by epithelial regeneration, typically achieving over 90% closure within 4 weeks and complete reepithelialization by 8 weeks.Despite this, delayed healing occurs in 5–20% of patients. Major risk factors include Helicobacter pylori infection, large ulcer size, antral location, and high-grade dysplasia or early gastric cancer. Acid suppression remains the cornerstone of therapy. Proton pump inhibitors promote healing through potent acid inhibition and cyclooxygenase-2-mediated mucosal regeneration, whereas potassium-competitive acid blockers provide faster, stronger, and cytochrome P450 2C19-independent acid suppression, offering advantages during the early high-risk period.Mucoprotective agents, such as rebamipide and sucralfate, further enhance epithelial repair and reduce mechanical or chemical irritation. Endoscopic closure techniques―including clipping, use of over-the-scope devices, loop-clip methods, and the application of polyglycolic acid sheets with fibrin glue―offer additional protection and help reduce delayed bleeding. Emerging advances include artificial intelligence-based prediction models for delayed bleeding, biomaterialassisted tissue regeneration, and precision treatment tailored to genetics, ulcer characteristics, and patient-specific risk factors. Collectively, these developments are reshaping post-ESD ulcer management toward more individualized and proactive care.
