The Importance of pH Adjustment for Preventing Fibrin Glue Dissolution in the Stomach: an in Vitro Study
Abstract Background and study aim: Combined use of fibrin glue and polyglycolic acid (PGA) sheets has attracted attention as a preventive measure for complications associated with endoscopic submucosal dissection. However, fibrin glue is a protein that may be dissolved by gastric acid. We evaluated the effect of artificial gastric acid on fibrin clot.Materials and methods: The dissolution time of three layers of fibrin glue with PGA sheets was measured in five groups (pH 1.2, 2.0, 4.0, 5.5, and 6.0 with pepsin). Measurements of three samples per group were made. The mean number of the remaining layers at each measurement point was observed for seven days.Results: The time to complete dissolution of the three layers of fibrin gel in the three samples was 150 minutes at pH 1.2, 5 hours at pH 2.0, 24 hours at pH 4.0, and 2 days and 6 hours at pH 5.5. Conclusion: In order to maintain fibrin glue in the stomach for a long period, there was a need to avoid pepsin activation secondary to acidification of gastric juice. The use of strong antacids is recommended.