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

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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Polyglycolic acid sheet and fibrin glue for preventing esophageal stricture after endoscopic submucosal dissection: a historical control study

Diseases of the Esophagus ◽

10.1093/dote/dox053 ◽

2017 ◽

Vol 30 (11) ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

T. Iizuka ◽

D. Kikuchi ◽

S. Hoteya ◽

Y. Kajiyama ◽

M. Kaise

Keyword(s):

Endoscopic Submucosal Dissection ◽

Fibrin Glue ◽

Esophageal Stricture ◽

Polyglycolic Acid ◽

Historical Control ◽

Polyglycolic Acid Sheet ◽

Submucosal Dissection ◽

Control Study

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379 Utility of Autologous Fibrin Glue and Polyglycolic Acid Sheets for Prevention of Delayed Bleeding After Gastric Endoscopic Submucosal Dissection Under Antithrombotic Therapy

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.091 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB73

Author(s):

Daisuke Kikuchi ◽

Toshiro Iizuka ◽

Shu Hoteya ◽

Misturu Kaise

Keyword(s):

Endoscopic Submucosal Dissection ◽

Fibrin Glue ◽

Antithrombotic Therapy ◽

Polyglycolic Acid ◽

Delayed Bleeding ◽

Submucosal Dissection ◽

Autologous Fibrin Glue

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Combination of search, coagulation, clipping, and polyglycolic acid sheet to prevent delayed bleeding after gastric endoscopic submucosal dissection

Endoscopy ◽

10.1055/a-1122-8541 ◽

2020 ◽

Vol 52 (09) ◽

pp. E344-E345 ◽

Cited By ~ 1

Author(s):

Satoshi Abiko ◽

Ayumu Yoshikawa ◽

Kazuaki Harada ◽

Naoki Kawagishi ◽

Itsuki Sano ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

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

10.21203/rs.3.rs-56039/v2 ◽

2020 ◽

Author(s):

Satoshi Abiko ◽

Soichiro Oda ◽

Akimitsu Meno ◽

Akane Shido ◽

Sonoe Yoshida ◽

...

Keyword(s):

High Risk ◽

Endoscopic Submucosal Dissection ◽

Fibrin Glue ◽

Polyglycolic Acid ◽

Low Risk ◽

R0 Resection ◽

Antithrombotic Agents ◽

En Bloc ◽

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 (PGA) 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.Methods: 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 resection time of the MSCC method was 16 min, and the median speed (the resection area divided by the resection time) was 3.6 cm2/10 min. The median resection 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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Polyglycolic Acid Felt Sealing Method for Prevention of Bleeding Related to Endoscopic Submucosal Dissection in Patients Taking Antithrombotic Agents

Gastroenterology Research and Practice ◽

10.1155/2016/1457357 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 13

Author(s):

Hiroko Fukuda ◽

Naoyuki Yamaguchi ◽

Hajime Isomoto ◽

Kayoko Matsushima ◽

Hitomi Minami ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Fibrin Glue ◽

Therapy Group ◽

Polyglycolic Acid ◽

Antithrombotic Agents ◽

Delayed Bleeding ◽

Link Type ◽

Submucosal Dissection ◽

Prevention Method ◽

Pga Felt

Background and Study Aims. When performing endoscopic submucosal dissection (ESD) for patients on antithrombotic agents, the frequency of delayed bleeding is expected to increase. The endoscopic polyglycolic acid (PGA) felt and fibrin glue sealing method could be a new method for prevention of delayed bleeding.Patients and Methods. The safety and efficacy of the endoscopic tissue sealing method with PGA sheets and fibrin glue for the prevention of post-ESD bleeding were examined in 104 patients taking antithrombotic agents. During the study period, 70 patients taking antithrombotic agents did not undergo the sealing method, 36 patients discontinued antithrombotic agents, and 724 patients had not received antithrombotic therapy.Results. Delayed bleeding rates were 3.8% (4/104) in the sealing group, 12.9% (9/70) in the nonsealing group, 8.3% (3/36) in the discontinuation group, and 4.6% (33/724) in the nonantithrombotic therapy group. Thus, the delayed bleeding rate was significantly lower in the sealing group than in the nonsealing group and comparable to that in the nonantithrombotic therapy group.Conclusions. This PGA felt and fibrin glue sealing method might become a promising post-ESD bleeding prevention method in patients taking antithrombotic agents (UMIN000013990,UMIN000013993).

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Feasibility of Autologous Fibrin Glue and Polyglycolic Acid Sheets to Prevent Delayed Bleeding after Endoscopic Submucosal Dissection of Gastric Neoplasms in Patients Receiving Antithrombotic Therapy

Gastroenterology Research and Practice ◽

10.1155/2018/2174957 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Daisuke Kikuchi ◽

Toshiro Iizuka ◽

Kosuke Nomura ◽

Yasutaka Kuribayashi ◽

Masami Tanaka ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Fibrin Glue ◽

Antithrombotic Therapy ◽

Polyglycolic Acid ◽

Safety Measure ◽

Gastric Neoplasms ◽

Delayed Bleeding ◽

Submucosal Dissection ◽

Autologous Fibrin Glue

Background/Aims. Delayed bleeding is one of the most serious complications following gastric endoscopic submucosal dissection (ESD) under antithrombotic therapy. As a safety measure, for patients receiving antithrombotic therapy, we covered the ESD ulcer with autologous fibrin glue (prepared using autologous blood) alone or with polyglycolic acid (PGA) sheets. Methods. From July 2014 to November 2015, 20 patients with gastric neoplasms who were receiving antithrombotic therapy were enrolled in this study. After ESD, the ESD ulcers were covered with autologous fibrin glue alone or with PGA sheets. We prospectively evaluated the feasibility of this safety measure. Results. In total, 22 lesions in 20 patients were resected en bloc by ESD. The mean specimen size and tumor size were 31.5 ± 9.5 mm and 14.0 ± 8.8 mm, respectively. There were no cases of delayed bleeding or adverse events in this study. Attachment of autologous fibrin glue was observed in 81.8% (18/22) and 68.2% (15/22) of lesions at endoscopy performed 1 day and 7 days after ESD, respectively. Conclusion. No patient in this study had delayed bleeding or adverse events. This suggests that this measure may facilitate the safety of gastric ESD in patients receiving antithrombotic therapy. This trial is registered with UMIN000019386.

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