Advertisement

Gastric Cancer

, Volume 21, Issue 4, pp 696–702 | Cite as

Efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued antithrombotic agents

  • Noboru Kawata
  • Hiroyuki Ono
  • Kohei Takizawa
  • Naomi Kakushima
  • Masaki Tanaka
  • Kimihiro Igarashi
  • Masao Yoshida
  • Yoshihiro Kishida
  • Tomohiro Iwai
  • Sayo Ito
  • Kenichiro Imai
  • Kinichi Hotta
  • Hirotoshi Ishiwatari
  • Hiroyuki Matsubayashi
Original Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued antithrombotic agents.

Keywords

Endoscopic submucosal dissection Early gastric cancer Antithrombotic therapy Polyglycolic acid sheet Fibrin glue 

Notes

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

Informed consent or a substitute for such consent was obtained from all patients before inclusion in our study.

References

  1. 1.
    Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol. 2005;62:1217–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med. 1998;158:1610–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Palareti G, Legnani C, Guazzaloca G, Frascaro M, Grauso F, De Rosa F, et al. Activation of blood coagulation after abrupt or stepwise withdrawal of oral anticoagulants—a prospective study. Thromb Haemost. 1994;72:222–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Fujimoto K, Fujishiro M, Kato M, Higuchi K, Iwakiri R, Sakamoto C, et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc. 2014;26:1–14.CrossRefPubMedGoogle Scholar
  5. 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
  6. 6.
    Ono H, Yao K, Fujishiro M, Oda I, Nimura S, Yahagi N, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc. 2016;28:3–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Ono S, Fujishiro M, Yoshida N, Doyama H, Kamoshida T, Hirai S, et al. Thienopyridine derivatives as risk factors for bleeding following high risk endoscopic treatments: safe treatment on antiplatelets (STRAP) study. Endoscopy. 2015;47:632–7.CrossRefPubMedGoogle Scholar
  8. 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
  9. 9.
    Cho SJ, Choi IJ, Kim CG, Lee JY, Nam BH, Kwak MH, et al. Aspirin use and bleeding risk after endoscopic submucosal dissection in patients with gastric neoplasms. Endoscopy. 2012;44:114–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Tounou S, Morita Y, Hosono T. Continuous aspirin use does not increase post-endoscopic dissection bleeding risk for gastric neoplasms in patients on antiplatelet therapy. Endosc Int Open. 2015;3:E31–8.PubMedGoogle Scholar
  11. 11.
    Tsuji Y, Fujishiro M, Kodashima S, Ono S, Niimi K, Mochizuki 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;81:906–12.CrossRefPubMedGoogle Scholar
  12. 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
  13. 13.
    Hayashibe A, Sakamoto K, Shinbo M, Makimoto S, Nakamoto T. New method for prevention of bile leakage after hepatic resection. J Surg Oncol. 2006;94:57–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Kawai H, Harada K, Ohta H, Tokushima T, Oka S. Prevention of alveolar air leakage after video-assisted thoracic surgery: comparison of the efficacy of methods involving the use of fibrin glue. Thorac Cardiovasc Surg. 2012;60:351–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Takeuchi J, Suzuki H, Murata M, Kakei Y, Ri S, Umeda M, Komori T. Clinical evaluation of application of polyglycolic acid sheet and fibrin glue spray for partial glossectomy. J Oral Maxillofac Surg. 2013;71:e126–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Takimoto K, Toyonaga T, Matsuyama K. Endoscopic tissue shielding to prevent delayed perforation associated with endoscopic submucosal dissection for duodenal neoplasms. Endoscopy. 2012;44((Suppl 2 UCTN)):E414–5.PubMedGoogle Scholar
  17. 17.
    Takimoto K, Imai Y, Matsuyama K. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to prevent delayed perforation after duodenal endoscopic submucosal dissection. Dig Endosc. 2014;26(Suppl 2):46–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Iizuka T, Kikuchi D, Yamada A, Hoteya S, Kajiyama Y, Kaise M. Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma. Endoscopy. 2015;47:341–4.PubMedGoogle Scholar
  19. 19.
    Sakaguchi Y, Tsuji Y, Ono S, Saito I, Kataoka Y, Takahashi Y, et al. Polyglycolic acid sheets with fibrin glue can prevent esophageal stricture after endoscopic submucosal dissection. Endoscopy. 2015;47:336–40.PubMedGoogle Scholar
  20. 20.
    Ono H, Takizawa K, Kakushima N, Tanaka M, Kawata N. Application of polyglycolic acid sheets for delayed perforation after endoscopic submucosal dissection of early gastric cancer. Endoscopy. 2015;47(Suppl 1 UCTN):E18–9.PubMedGoogle Scholar
  21. 21.
    Ono H, Hasuike N, Inui T, Takizawa K, Ikehara H, Yamaguchi Y, et al. Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer. Gastric Cancer. 2008;11:47–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Tanaka M, Ono H, Hasuike N, Takizawa K. Endoscopic submucosal dissection of early gastric cancer. Digestion. 2008;77(Suppl 1):23–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Kakushima N, Ono H, Tanaka M, Takizawa K, Yamaguchi Y, Matsubayashi H. Endoscopic submucosal dissection using the insulated-tip knife. Tech Gastrointest Endosc. 2011;13:63–9.CrossRefGoogle Scholar
  24. 24.
    Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection: an analysis of risk factors. Endoscopy. 2008;40:179–83.CrossRefPubMedGoogle Scholar
  25. 25.
    Sung JJ, Lau JY, Ching JY, Wu JC, Lee YT, Chiu PW, et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med. 2010;152:1–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Igarashi K, Takizawa K, Kakushima N, Tanaka M, Kawata N, Yoshida M, et al. Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection? Surg Endosc. 2017;31:1746–53.CrossRefPubMedGoogle Scholar
  27. 27.
    Sanomura Y, Oka S, Tanaka S, Numata N, Higashiyama M, Kanao H, et al. Continued use of low-dose aspirin does not increase the risk of bleeding during or after endoscopic submucosal dissection for early gastric cancer. Gastric Cancer. 2014;17:489–96.CrossRefPubMedGoogle Scholar
  28. 28.
    Lim JH, Kim SG, Kim JW, Choi YJ, Kwon J, Kim JY, et al. Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms? Gastrointest Endosc. 2012;75:719–27.CrossRefPubMedGoogle Scholar
  29. 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. 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. 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.
  32. 32.
    Choi KD, Jung HY, Lee GH, Oh TH, Jo JY, Song HJ, et al. Application of metal hemoclips for closure of endoscopic mucosal resection-induced ulcers of the stomach to prevent delayed bleeding. Surg Endosc. 2008;22:1882–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Lee BI, Kim BW, Kim HK, Choi H, Ji JS, Hwang SM, et al. Routine mucosal closure with a detachable snare and clips after endoscopic submucosal dissection for gastric epithelial neoplasms: a randomized controlled trial. Gut Liver. 2011;5:454–9.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Okada K, Yamamoto Y, Kasuga A, Omae M, Kubota M, Hirasawa T, et al. Risk factors for delayed bleeding after endoscopic submucosal dissection for gastric neoplasm. Surg Endosc. 2011;25:98–107.CrossRefPubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Noboru Kawata
    • 1
  • Hiroyuki Ono
    • 1
  • Kohei Takizawa
    • 1
  • Naomi Kakushima
    • 1
  • Masaki Tanaka
    • 1
  • Kimihiro Igarashi
    • 1
  • Masao Yoshida
    • 1
  • Yoshihiro Kishida
    • 1
  • Tomohiro Iwai
    • 1
  • Sayo Ito
    • 1
  • Kenichiro Imai
    • 1
  • Kinichi Hotta
    • 1
  • Hirotoshi Ishiwatari
    • 1
  • Hiroyuki Matsubayashi
    • 1
  1. 1.Division of EndoscopyShizuoka Cancer CenterNagaizumiJapan

Personalised recommendations