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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1542-E1548
DOI: 10.1055/a-1007-1694
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

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

Daisuke Kikuchi
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Toshiro Iizuka
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Shigeyoshi Makino
2   Department of Transfusion medicine, Toranomon Hospital, Tokyo, Japan
,
Junnosuke Hayasaka
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Hiroyuki Odagiri
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Yorinari Ochiai
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Yugo Suzuki
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Kosuke Nomura
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Yu Ohkura
3   Department of Surgery, Toranomon Hospital, Tokyo, Japan
,
Yosuke Okamoto
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Masami Tanaka
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Akira Matsui
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Toshifumi Mitani
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Shu Hoteya
1   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 01 March 2019

accepted after revision 23 August 2019

Publication Date:
11 November 2019 (online)

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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.

 

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