Endoscopic closure of an anastomo-cutaneous fistula: Filling and shielding using polyglycolic acid sheets and fibrin glue with easily deliverable technique

Abstract Background and study aims Recently, endoscopic closure of gastrointestinal fistulas using polyglycolic acid (PGA) sheets with fibrin glue (FG) has been attempted. A 70-year-old woman who had undergone pancreaticoduodenectomy for pancreatic cancer suffered from a refractory anastomo-cutaneous fistula at the site of gastro-jejunostomy. We attempted endoscopic closure with filling and shielding using PGA sheets and FG. After introducing a guidewire into the fistula, a small piece of PGA sheet was skewered onto the guidewire and then pushed using a tapered catheter over the guidewire and delivered into the fistula. A total of 10 sheets were delivered via the same procedure. Next, the mucosa around the fistula was ablated, and the orifice of the fistula along with the surrounding mucosa was shielded with a piece of PGA sheet fixed with hemoclips and FG. After this procedure, the leakage disappeared and the fistula was undetectable on contrast radiograms. Endoscopic closure of anastomo-cutaneous fistula with filling and shielding using PGA sheets and FG is an effective, safe, low-invasive treatment, and the filling technique using a guidewire ensures a safe, smooth procedure.

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Endoscopic closure of refractory esophageal fistula after esophagectomy using polyglycolic acid sheets: a pilot study

Endoscopy International Open ◽

10.1055/a-1119-6352 ◽

2020 ◽

Vol 08 (05) ◽

pp. E591-E595 ◽

Cited By ~ 1

Author(s):

Yasuaki Nagami ◽

Masaki Ominami ◽

Taishi Sakai ◽

Shusei Fukunaga ◽

Fumio Tanaka ◽

...

Keyword(s):

Pilot Study ◽

Adverse Events ◽

Fibrin Glue ◽

Polyglycolic Acid ◽

Poor Quality ◽

Esophageal Fistula ◽

Fistula Closure ◽

Prospective Pilot Study ◽

Endoscopic Closure

Abstract Background and study aims Esophageal fistulas after esophagectomy are associated with high mortality and poor quality of life. They are sometimes intractable to conservative management and surgery that increases mortality. Few studies have assessed use of polyglycolic acid (PGA) sheets with fibrin glue for esophageal fistulas. We investigated the safety of using PGA sheets with fibrin glue for esophageal fistulas after esophagectomy. Patients and methods This was a single-center prospective pilot study. Patients who had refractory esophageal fistulas after esophagectomy were included. PGA sheets were filled in the fistula using biopsy forceps. Fibrin glue was applied to the PGA sheets. We repeated the procedure 1 week later. The outcome measures were the incidence of adverse events (AEs) and closure of the fistula. Results Five patients were assessed. No adverse events were observed. The esophageal fistula was closed with the application of PGA sheets four times in 40 % (2/5) of the cases. Conclusions PGA sheets with fibrin glue were safe for esophageal fistula closure after esophagectomy and do not involve the risk of AEs.

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Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor

Case Reports in Gastroenterology ◽

10.1159/000494918 ◽

2018 ◽

Vol 12 (3) ◽

pp. 679-685

Author(s):

Ko Watanabe ◽

Takuto Hikichi ◽

Jun Nakamura ◽

Minami Hashimoto ◽

Tadayuki Takagi ◽

...

Keyword(s):

Duodenal Ulcer ◽

Proton Beam ◽

Fibrin Glue ◽

Liver Tumor ◽

Proton Beam Therapy ◽

Polyglycolic Acid ◽

Omental Patch ◽

Perforation Site ◽

Endoscopic Closure ◽

First Case

We describe the first case of a nonhealing duodenal ulcer with perforation after proton beam therapy (PBT) of a liver tumor that was successfully treated endoscopically using polyglycolic acid (PGA) sheets with fibrin glue. A 69-year-old man received PBT for a liver tumor. Esophagogastroduodenoscopy (EGD) 3 months after PBT revealed a duodenal ulcer. A proton pump inhibitor was administered for 7 weeks, and the ulcer healed. Six months after the EGD, recurrence of the duodenal ulcer with perforation occurred. An emergency open surgery with placement of the omental patch was performed. However, 5 days after the surgery, because the EGD revealed a perforation site in the duodenal ulcer that was not closed, the conservative treatment was continued. Twenty-eight days after the surgery, EGD revealed that the perforation size had increased. Therefore, we conducted endoscopic closure therapy using PGA sheets with fibrin glue. Eleven days after the closure procedure, the EGD showed that the perforation site was filled with granulation tissue and was closed. Forty-nine days after the procedure, EGD revealed that the ulcer had healed. This endoscopic closure treatment was effective for a nonhealing duodenal ulcer with perforation after PBT of a liver tumor.

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Endoscopic Closure of an Acute Duodenal Perforation Occurring during Endoscopic Ultrasound Using Endoclips and Polyglycolic Acid Sheets with Fibrin Glue

Case Reports in Gastroenterology ◽

10.1159/000512474 ◽

2021 ◽

pp. 253-261

Author(s):

Mana Matsuoka ◽

Katsumasa Kobayashi ◽

Yukito Okura ◽

Tomohiro Mochida ◽

Takahito Nozaka ◽

...

Keyword(s):

Fibrin Glue ◽

Endoscopic Ultrasound ◽

Endoscopic Treatment ◽

Duodenal Bulb ◽

Pancreatic Head ◽

Polyglycolic Acid ◽

Duodenal Perforation ◽

Perforation Site ◽

Endoscopic Closure ◽

Duodenal Perforations

Acute duodenal perforation during endoscopic ultrasound (EUS) is a serious complication. The conventional endoscopic treatment for duodenal perforations such as endoscopic clipping is unsatisfactory; recently, the effectiveness of over-the-scope clipping (OTSC) has been reported. A 91-year-old woman was referred to our hospital with the chief complaint of jaundice. Contrast-enhanced computed tomography showed a 2-cm mass in the pancreatic head; we planned EUS-guided fine-needle aspiration. During exploration for a puncture route from the duodenal bulb using a linear echoendoscope under carbon dioxide insufflation, the duodenal lumen was suddenly filled with blood. A perforation <15 mm was identified in the superior duodenal horn. We attempted an endoscopic closure with multiple endoclips but could not completely close the perforation site. Strips of bioabsorbable polyglycolic acid (PGA) sheets were placed over the gaps between the endoclips with biopsy forceps and fixed in place with fibrin glue, completely covering the perforation site. Two days after the procedure, the perforation site had closed. Nine days later, endoscopic biliary stenting was performed. The patient was diagnosed with pancreatic cancer through bile cytology, and the optimal supportive care for her age was selected. Endoscopic tissue shielding with PGA sheets and fibrin glue is increasingly being reported for use during gastrointestinal endoscopic procedures. In this case, surgery was avoided due to successful endoscopic treatment using endoclips and PGA sheets with fibrin glue without OTSC. This method may be useful for repairing acute duodenal perforations during EUS and should therefore be known to pancreatobiliary endoscopists.

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Modified search, coagulation, and clipping with polyglycolic acid sheet and fibrin glue to reduce delayed bleeding risk after endoscopic submucosal dissection near the dentate line

Endoscopy ◽

10.1055/a-1422-2510 ◽

2021 ◽

Author(s):

Satoshi Abiko ◽

Ayumu Yoshikawa ◽

Kazuaki Harada ◽

Naoki Kawagishi ◽

Itsuki Sano ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Fibrin Glue ◽

Bleeding Risk ◽

Dentate Line ◽

Polyglycolic Acid ◽

Delayed Bleeding ◽

Polyglycolic Acid Sheet ◽

Submucosal Dissection

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Feasibility of a modified search, coagulation, and clipping method with and without the use of polyglycolic acid sheets and fibrin glue for preventing delayed bleeding after gastric endoscopic submucosal dissection

BMC Gastroenterology ◽

10.1186/s12876-020-01539-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Satoshi Abiko ◽

Soichiro Oda ◽

Akimitsu Meno ◽

Akane Shido ◽

Sonoe Yoshida ◽

...

Keyword(s):

High Risk ◽

Endoscopic Submucosal Dissection ◽

Median Time ◽

Fibrin Glue ◽

Polyglycolic Acid ◽

Low Risk ◽

R0 Resection ◽

Antithrombotic Agents ◽

Delayed Bleeding ◽

Submucosal Dissection

Abstract Background Methods have been developed for preventing delayed bleeding (DB) after gastric endoscopic submucosal dissection (GESD). However, none of the methods can completely prevent DB. We hypothesized that DB could be prevented by a modified search, coagulation, and clipping (MSCC) method for patients at low risk for DB and by combining the use of polyglycolic acid sheets and fibrin glue with the MSCC method (PMSCC method) for patients at high risk for DB (antibleeding [ABI] strategy). This study assessed the technical feasibility of this novel strategy. Method We investigated 123 lesions in 121 consecutive patients who underwent GESD in Kushiro Rosai Hospital between April 2018 and January 2020. The decision for continuation or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment. Results Oral antithrombotic agents were administered to 28 patients (22.8%). The en bloc R0 resection rate was 98.4%. The MSCC method and the PMSCC method for preventing DB were performed in 114 and 9 lesions, respectively. The median time of the MSCC method was 16 min, and the median speed (the resection area divided by the time of method used) was 3.6 cm2/10 min. The median time of the PMSCC method was 59 min, and the median speed was 1.3 cm2/10 min. The only delayed procedural adverse event was DB in 1 (0.8%) of the 123 lesions. Conclusions The ABI strategy is feasible for preventing DB both in patients at low risk and in those at high risk for DB after GESD, whereas the PMSCC method may be necessary for reduction of time.

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Nonsuture dural repair using polyglycolic acid mesh and fibrin glue: clinical application to spinal surgery

Surgical Neurology ◽

10.1016/j.surneu.2005.07.059 ◽

2006 ◽

Vol 65 (2) ◽

pp. 136-142 ◽

Cited By ~ 60

Author(s):

Kazutoshi Hida ◽

Satoshi Yamaguchi ◽

Toshitaka Seki ◽

Shunsuke Yano ◽

Minoru Akino ◽

...

Keyword(s):

Fibrin Glue ◽

Clinical Application ◽

Spinal Surgery ◽

Polyglycolic Acid ◽

Dural Repair ◽

Polyglycolic Acid Mesh

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Fibrin adhesive and the vaginal vault synthesis on female rabbits abdominal hysterectomies

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502009000100007 ◽

2009 ◽

Vol 24 (1) ◽

pp. 30-35 ◽

Cited By ~ 1

Author(s):

Ari Gonçalves Lima ◽

Murched Omar Taha ◽

Henri Chaplin Rivoire ◽

Anna Tereza Negrini Fagundes ◽

Djalma José Fagundes

Keyword(s):

Fibrin Glue ◽

Granulation Tissue ◽

Fibrous Tissue ◽

Rabbit Model ◽

Abdominal Hysterectomy ◽

Polyglycolic Acid ◽

Vaginal Vault ◽

Fisher Test ◽

Burst Test ◽

Significant Difference

PURPOSE: To investigate the effectiveness of fibrin glue in comparison with polyglycolic acid suture to promote the closure of rabbit's vaginal vault, after abdominal hysterectomy. METHODS: Twenty female, adults, New Zealand rabbits, were submitted to abdominal hysterectomy and randomly distributed to polyglycolic acid suture (G-PA / n=10) or fibrin glue closure of vaginal vault (G-FG / n=10). Radiograph study allowed identifying vault vaginal suture disrupter or fistulas to urinary bladder or rectum. Videovaginoscopy study allowed identifying the presence of cellulites, abscess formation, tissue granulation or granuloma. Vaginal cuff burst test allowed to identify by the escape of air bubbles and rupture pression record. Histological sections stained with Picrosirius red allowed the measure of fibrous tissue healing. RESULTS: The videovaginoscopy identified a significant difference (Fisher Test p<0.3142) of granulation tissue in the animals of G-PA (40%) in comparison with the G-FG (20%). The gross inspection showed the same relation in the granulation tissue occurrence (Fisher test p< 0.1749) with G-PA (50%) and G-FB (20%). The visceral adhesion to the vaginal vault wound was statistical significant (Fisher test p< 0.1749) with G-PA (50%) and G-FG (20%). The pressure of rupture (mm Hg) of the burst test was similar (p<0.0421) in the animals of G-PA (61.5±19.3) and G-FG (72.5±21.9). The collagen matrix of vault wound healing was similar (p< 0.0231) between the G-PA (31.63±15) and the G-FG (23.2±13.2). CONCLUSION: The vaginal vault closure using the fibrin glue is a safe and reliable procedure after abdominal hysterectomy in female rabbit model.

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