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. 2018 Mar 4:2018:2174957.
doi: 10.1155/2018/2174957. eCollection 2018.

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

Daisuke Kikuchi  1 , Toshiro Iizuka  1 , Kosuke Nomura  1 , Yasutaka Kuribayashi  1 , Masami Tanaka  1 , Satoshi Yamashita  1 , Tsukasa Furuhata  1 , Akira Matsui  1 , Toshifumi Mitani  1 , Shigeyoshi Makino  2 , Shu Hoteya  1
Affiliations

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

Daisuke Kikuchi et al. Gastroenterol Res Pract. .

Abstract

Background/aims: Delayed bleeding is one of the most serious complications following gastric endoscopic submucosal dissection (ESD) under antithrombotic therapy. As a safety measure, for patients receiving antithrombotic therapy, we covered the ESD ulcer with autologous fibrin glue (prepared using autologous blood) alone or with polyglycolic acid (PGA) sheets.

Methods: From July 2014 to November 2015, 20 patients with gastric neoplasms who were receiving antithrombotic therapy were enrolled in this study. After ESD, the ESD ulcers were covered with autologous fibrin glue alone or with PGA sheets. We prospectively evaluated the feasibility of this safety measure.

Results: In total, 22 lesions in 20 patients were resected en bloc by ESD. The mean specimen size and tumor size were 31.5 ± 9.5 mm and 14.0 ± 8.8 mm, respectively. There were no cases of delayed bleeding or adverse events in this study. Attachment of autologous fibrin glue was observed in 81.8% (18/22) and 68.2% (15/22) of lesions at endoscopy performed 1 day and 7 days after ESD, respectively.

Conclusion: No patient in this study had delayed bleeding or adverse events. This suggests that this measure may facilitate the safety of gastric ESD in patients receiving antithrombotic therapy. This trial is registered with UMIN000019386.

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Figures

Figure 1
Figure 1
(a) Endoscopic view of the lesion. The lesion is located at the lesser curvature of the lower gastric body. (b) ESD ulcer. Visible blood vessels were coagulated using hemostasis forceps. (c) Polyglycolic acid (PGA) sheet was applied using biopsy forceps and fixed using clips. (d) Autologous fibrinogen and bovine thrombin solution were sprayed simultaneously to bond the PGA sheet. (e) Endoscopic view of ESD ulcer 1 day after ESD. (f) Endoscopic view of ESD ulcer 7 days after ESD. This patient was discharged from our hospital without any symptom of bleeding.
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