Polyglycolic acid sheets and fibrin glue decrease the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms (with video).

Abstract

BACKGROUND:

The prevention of bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms is still an important problem.

OBJECTIVE:

To investigate the efficacy and safety of a shielding method that uses polyglycolic acid (PGA) sheets and fibrin glue to prevent post-ESD bleeding in high-risk patients.

DESIGN:

A nonrandomized trial with historical control subjects.

SETTING:

A single academic hospital in Japan.

PATIENTS:

From July 2013 to February 2014, 45 ESD-induced ulcers in 41 patients with a high risk of bleeding were enrolled in a study group. Forty-one consecutive ESD-induced ulcers in 37 control subjects with a high risk of bleeding were treated in 2013 before the first enrollment.

INTERVENTIONS:

We placed PGA sheets on the mucosal defect and fixed with fibrin glue in the study group.

MAIN OUTCOME MEASUREMENTS:

The post-ESD bleeding rate.

RESULTS:

The post-ESD bleeding occurred at a rate of 6.7% in the study group (3/45 lesions) and 22.0% in the historical control group (9/41 lesions). There was a significant difference in the post-ESD bleeding rate between the 2 groups (P = .041).

LIMITATIONS:

A nonrandomized trial with historical control subjects; a single-center analysis; small sample size.

CONCLUSIONS:

The endoscopic tissue shielding method with PGA sheets and fibrin glue appears to be promising for the prevention of post-ESD bleeding.

CLINICAL TRIAL REGISTRATION NUMBER:

UMIN000011058.).

• Authors: Yosuke Tsuji, Mitsuhiro Fujishiro, Shinya Kodashima, Satoshi Ono, Keiko Niimi, Satoshi Mochizuki, Itsuko Asada-Hirayama, Rie Matsuda, Chihiro Minatsuki, Chiemi Nakayama, Yu Takahashi, Yoshiki Sakaguchi, Nobutake Yamamichi, Kazuhiko Koike
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 81 Issue 4 Pg. 906-12 (Apr 2015) ISSN: 1097-6779 [Electronic] United States
• PMID: 25440679 (Publication Type: Controlled Clinical Trial, Journal Article, Video-Audio Media)
• Copyright: Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biocompatible Materials
• Fibrin Tissue Adhesive
• Tissue Adhesives
• Polyglycolic Acid

Topics

• Aged
• Aged, 80 and over
• Biocompatible Materials (therapeutic use)
• Dissection (adverse effects)
• Female
• Fibrin Tissue Adhesive (therapeutic use)
• Gastric Mucosa (surgery)
• Gastrointestinal Hemorrhage (etiology, prevention & control)
• Gastroscopy
• Humans
• Male
• Polyglycolic Acid (therapeutic use)
• Prospective Studies
• Stomach Neoplasms (surgery)
• Tissue Adhesives (therapeutic use)