Utility of autologous fibrin glue and polyglycolic acid sheet for preventing delayed bleeding associated with antithrombotic therapy after gastric ESD

 

 Permissions and Reprints

Abstract

Background and study aims Delayed bleeding is one of the most serious adverse events of gastric endoscopic submucosal dissection (ESD), especially in patients taking antithrombotic therapy. This study aimed to evaluate the utility and safety of a shielding method with autologous fibrin glue and polyglycolic acid (PGA) sheets for patients undergoing gastric ESD who are receiving antithrombotic therapy.

Patients and methods One hundred twenty-three patients who were treated with gastric ESD while receiving antithrombotic therapy between December 2014 and September 2017 were enrolled in this study. Patients who received the shielding method were classified into the shielding group. Others were classified into the conventional group. Various clinico-pathological factors were retrospectively compared between the two groups.

Results The shielding group consisted of 38 patients, and the conventional group consisted of the remaining 85 patients. In the shielding group, the rate of continuation of antithrombotic therapy was significantly higher (68.4 % vs 41.2 %). Incidence of delayed bleeding was lower in the shielding group (2.6 %, 1/38) than in the conventional group (14.1 %, 12/85). In the propensity score-adjusted logistic regression analysis, the delayed bleeding rate in the shielding group tended to be lower than in the conventional group (P = 0.070). Allogeneic transfusion was performed in eight patients (8/85, 9.4 %) in the conventional group and none in the shielding group (P = 0.047). No adverse event associated with endoscopic shielding were observed in the shielding group.

Conclusions This study suggests that a shielding method with autologous fibrin glue and PGA sheet effectively prevents delayed bleeding after gastric ESD in patients receiving antithrombotic therapy.

• References

• 1 Application of U.S. guidelines in other contries: aspirin for the primary prevention of prevention of cardiovascular events in Japan. Am J Med 2014; 117: 459-468
  PubMedGoogle Scholar
• 2 Fujimoto K, Fujishiro M, Kato M. et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014; 26: 1-14
  PubMedGoogle Scholar
• 3 Kikuchi D, Iizuka T, Makino S. et al. 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. Gastroenterol Res Pract 2018; 2018: 2174957
  PubMedGoogle Scholar
• 4 Yano T, Haro A, Shikada Y. et al. A unique method for repairing intraoperative pulmonary air leakage with both polyglycolic acid sheets and fibrin glue. World J Surg 2012; 36: 463-467
  CrossrefPubMedGoogle Scholar
• 5 Kouketsu A, Nogami S, Fujiwara M. et al. Clinical evaluations of autologous fibrin glue and polyglycolic acid sheets as oral surgical wound coverings after partial glossectomy. J Craniomaxillofac Surg 2016; 44: 964-968
  CrossrefPubMedGoogle Scholar
• 6 Kikuchi D, Iizuka T, Hoteya S. et al. Usefulness of endoscopic ultrasound for the prediction of intraoperative bleeding of endoscopic submucosal dissection for gastric neoplasms. J Gastroenterol Hepatol 2011; 26: 68-72
  PubMedGoogle Scholar
• 7 Kikuchi D, Iizuka T, Hoteya S. et al. Prospective study about the utility of endoscopic ultrasound for predicting the safety of endoscopic submucosal dissection in early gastric cancer (T-HOPE 0801). Gastroenterol Res Pract 2013; 2013: 329385
  PubMedGoogle Scholar
• 8 Furuhata T, Kaise M, Hoteya S. et al. Postoperative bleeding after gastric endoscopic submucosal dissection in patients receiving antithrombotic therapy. Gastric Cancer 2017; 20: 207-214
  CrossrefPubMedGoogle Scholar
• 9 Oda I, Suzuki H, Nonaka S. et al. Complications of gastric endoscopic submucosal dissection. Dig Endosc 2013; 25: 71-78
  PubMedGoogle Scholar
• 10 Ueki N, Futagami S, Akimoto T. et al. Effect of antithrombotic therapy and long endoscopic submucosal dissection procedure time on early and delayed postoperative bleeding. Digestion 2017; 96: 21-28
  CrossrefPubMedGoogle Scholar
• 11 Niimi K, Fujishiro M, Goto O. et al. Prospective single-arm trial of two-week rabeprazole treatment for ulcer healing after gastric endoscopic submucosal dissection. Dig Endosc 2012; 24: 110-116
  PubMedGoogle Scholar
• 12 Yang Z, Wu Q, Liu Z. et al. Proton pump inhibitors versus histamine-2-receptor antagonists for the management of iatrogenic gastric ulcer after endoscopic mucosal resection or endoscopic submucosal dissection: a meta-analysis of randomized trials. Digestion 2011; 84: 315-320
  CrossrefPubMedGoogle Scholar
• 13 Maruoka D, Arai M, Kasamatsu S. et al. Vonoprazan is superior to proton pump inhibitors in healing artificial ulcers of the stomach post-endoscopic submucosal dissection: A propensity score-matching analysis. Dig Endosc 2017; 29: 57-64
  CrossrefPubMedGoogle Scholar
• 14 Tsuji Y, Fujishiro M, Kodashima S. et al. Polyglycolic acid sheets and fibrin glue decrease the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms (with video). Gastrointest Endosc 2015; 81: 906-912
  CrossrefPubMedGoogle Scholar
• 15 Kawata N, Ono H, Takizawa K. et al. Efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued antithrombotic agents. Gastric Cancer 2018; 2: 696-702
  PubMedGoogle Scholar
• 16 Kataoka Y, Tsuji Y, Hirasawa K. et al. Endoscopic tissue shielding to prevent bleeding after endoscopic submucosal dissection: a prospective multicenter randomized controlled trial. Endoscopy 2019; 51: 619-627
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Takimoto K, Toyonaga T, Matsuyama K. Endoscopic tissue shielding to prevent delayed perforation associated with endoscopic submucosal dissection for duodenal neoplasms. Endoscopy 2012; 44: E414-415
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Iizuka T, Kikuchi D, Yamada A. et al. Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma. Endoscopy 2015; 47: 341-344
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Sakaguchi Y, Tsuji Y, Ono S. et al. Polyglycolic acid sheets with fibrin glue can prevent esophageal stricture after endoscopic submucosal dissection. Endoscopy 2015; 47: 336-340
  Article in Thieme ConnectPubMedGoogle Scholar
• 20 Tsuji Y, Ohata K, Gunji T. et al. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to cover wounds after colorectal endoscopic submucosal dissection (with video). Gastrointest Endosc 2014; 79: 151-155
  CrossrefPubMedGoogle Scholar
• 21 Takeuchi J, Suzuki H, Murata M. et al. Clinical evaluation of application of polyglycolic acid sheet and fibrin glue spray for partial glossectomy. J Oral Maxillofac Surg 2013; 71: e126-e131
  CrossrefPubMedGoogle Scholar
• 22 Ono S, Tsuji Y, Fujishiro M. et al. An effective technique for delivery of polyglycolic acid sheet after endoscopic submucosal dissection of the esophagus: the clip and pull method. Endoscopy 2014; 46: E44-E45
  Article in Thieme ConnectPubMedGoogle Scholar