Endoscopic Treatment of Boerhaave Syndrome Using Polyglycolic Acid Sheets and Fibrin Glue: A Report of Two Cases

Anastomotic leak after gastrectomy is a major complication and various endoscopic methods have been suggested. However, the treatment of large-sized leaks remains a challenge. Here, we present a case of a large anastomotic leak successfully treated endoscopically using a combination of fibrin glue and polyglycolic acid (PGA) sheets. A 68-year-old man who underwent laparoscopic total gastrectomy and oesophagojejunal anastomosis presented with abdominal pain and fever. In the endoscopic examination, two fistulas were observed at the anastomosis site. One was small (0.6 cm) while the other measured 2.5 cm. For the large leak, endoscopic treatment using endoclip and detachable snare was attempted, but failed. Subsequently, fibrin glue was injected into the large fistula through an endoscope. After 28 days, the size of the fistula was reduced and PGA sheets were inserted into the remaining fistula. After about 4 weeks, leaks were observed to be completely healed.

Download Full-text

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.

Download Full-text

Endoscopic Treatment of Boerhaave Syndrome: A Surprisingly Quick Healing

10.26226/morressier.59a6b342d462b80290b541bb ◽

2017 ◽

Author(s):

Georgios Sakizlis

Keyword(s):

Endoscopic Treatment ◽

Boerhaave Syndrome

Download Full-text

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

Download Full-text

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.

Download Full-text

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

Download Full-text

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.

Download Full-text