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Gastrointest Endosc. 2015 Apr;81(4):906-12. doi: 10.1016/j.gie.2014.08.028. Epub 2014 Oct 29.

Polyglycolic acid sheets and fibrin glue decrease the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms (with video).

Author information

1
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
2
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
3
Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Abstract

BACKGROUND:

The prevention of bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms is still an important problem.

OBJECTIVE:

To investigate the efficacy and safety of a shielding method that uses polyglycolic acid (PGA) sheets and fibrin glue to prevent post-ESD bleeding in high-risk patients.

DESIGN:

A nonrandomized trial with historical control subjects.

SETTING:

A single academic hospital in Japan.

PATIENTS:

From July 2013 to February 2014, 45 ESD-induced ulcers in 41 patients with a high risk of bleeding were enrolled in a study group. Forty-one consecutive ESD-induced ulcers in 37 control subjects with a high risk of bleeding were treated in 2013 before the first enrollment.

INTERVENTIONS:

We placed PGA sheets on the mucosal defect and fixed with fibrin glue in the study group.

MAIN OUTCOME MEASUREMENTS:

The post-ESD bleeding rate.

RESULTS:

The post-ESD bleeding occurred at a rate of 6.7% in the study group (3/45 lesions) and 22.0% in the historical control group (9/41 lesions). There was a significant difference in the post-ESD bleeding rate between the 2 groups (P = .041).

LIMITATIONS:

A nonrandomized trial with historical control subjects; a single-center analysis; small sample size.

CONCLUSIONS:

The endoscopic tissue shielding method with PGA sheets and fibrin glue appears to be promising for the prevention of post-ESD bleeding. (

CLINICAL TRIAL REGISTRATION NUMBER:

UMIN000011058.).

PMID:
25440679
DOI:
10.1016/j.gie.2014.08.028
[Indexed for MEDLINE]

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