Efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued antithrombotic agents
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A novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking antithrombotic agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued antithrombotic agents.
One hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued antithrombotic agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared.
No significant differences were seen in the number and type of antithrombotic agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06–0.89). No adverse events were associated with the use of PGA sheets and fibrin glue.
The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued antithrombotic agents.
KeywordsEndoscopic submucosal dissection Early gastric cancer Antithrombotic therapy Polyglycolic acid sheet Fibrin glue
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human rights statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
Informed consent or a substitute for such consent was obtained from all patients before inclusion in our study.
- 5.Veitch AM, Vanbiervliet G, Gershlick AH, Boustiere C, Baglin TP, Smith LA, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy. 2016;48:385–402.CrossRefPubMedGoogle Scholar
- 8.Yoshio T, Nishida T, Kawai N, Yuguchi K, Yamada T, Yabuta T, et al. Gastric ESD under heparin replacement at high-risk patients of thromboembolism is technically feasible but has a high risk of delayed bleeding: Osaka University ESD Study Group. Gastroenterol Res Pract. 2013;2013:365830.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Fukuda H, Yamaguchi N, Isomoto H, Matsushima K, Minami H, Akazawa Y, et al. Polyglycolic acid felt sealing method for prevention of bleeding related to endoscopic submucosal dissection in patients taking antithrombotic agents. Gastroenterol Res Pract. 2016;2016:1457357.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Mochizuki S, Uedo N, Oda I, Kaneko K, Yamamoto Y, Yamashina T, et al. Scheduled second-look endoscopy is not recommended after endoscopic submucosal dissection for gastric neoplasms (the SAFE trial): a multicentre prospective randomised controlled non-inferiority trial. Gut. 2015;64:397–405.CrossRefPubMedGoogle Scholar
- 30.Matsumura T, Arai M, Maruoka D, Okimoto K, Minemura S, Ishigami H, et al. Risk factors for early and delayed post-operative bleeding after endoscopic submucosal dissection of gastric neoplasms, including patients with continued use of antithrombotic agents. BMC Gastroenterol. 2014;14:172.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Furuhata T, Kaise M, Hoteya S, Iizuka T, Yamada A, Nomura K, et al. Postoperative bleeding after gastric endoscopic submucosal dissection in patients receiving antithrombotic therapy. Gastric Cancer. 2016. https://doi.org/10.1007/s10120-015-0588-7.