Tissue shielding with polyglycolic acid sheets and fibrin glue on ulcers induced by endoscopic submucosal dissection in a porcine model

Background and study aims: The safety and efficacy of the application of polyglycolic acid (PGA) sheets with fibrin glue to ulcers induced by endoscopic submucosal dissection (ESD) have not been established in the treatment of lesions of the gastrointestinal tract, in which the influence of digestive fluid and peristalsis may affect treatment, and there may also be a risk of infection. The aims of this study were to evaluate the healing process of ESD-induced ulcers in animals treated with the application of a PGA sheet with fibrin glue and to verify experimentally the safety of this treatment procedure.

Materials and methods: Gastric ESD was performed in nine pigs under general anesthesia. Two ulcer sites were prepared in each pig; one ulcer was treated by applying a PGA sheet with fibrin glue (treated ulcer site), while the other ulcer was left untreated (control ulcer site). Three pigs were euthanized at week 1, three at week 4, and three at week 8 after ESD, and the ulcer sites were macroscopically and histopathologically evaluated.

Results: Of the nine treated ulcer sites, seven ulcer sites, to which a PGA sheet had been applied without exposure to the mucosal fluid, showed no peeling of the sheet despite the influence of peristalsis and gastric acid. Histopathologic examination revealed abundant, newly formed blood vessels in the treated ulcers and good granulation. In the treated ulcers, no excessive inflammation, necrosis, or infection was observed.

Conclusions: Our animal study experimentally demonstrated that this treatment technique can be safely applied to ESD-induced ulcers.

• References

• 1 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
• 2 Inoue T, Uedo N, Yamashina T et al. Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm. Dig Endosc 2014; 26: 220-227
• 3 Isomoto H, Yamaguchi N, Minami H et al. Management of complications associated with endoscopic submucosal dissection/endoscopic mucosal resection for esophageal cancer. Dig Endosc 2013; 25: 29-38
• 4 Park CH, Lee SK. Preventing and controlling bleeding in gastric endoscopic submucosal dissection. Clin Endosc 2013; 46: 456-462
• 5 Ohata K, Nonaka K, Minato Y et al. Endoscopic submucosal dissection for large colorectal tumor in a Japanese general hospital. J Oncol 2013; 2013: 218670
• 6 Takimoto K, Toyonaga T, Matsuyama K et al. Endoscopic tissue shielding to prevent delayed perforation associated with endoscopic submucosal dissection for duodenal neoplasms. Endoscopy 2012; 44: 414-415
• 7 Tsuji Y, Ohata K, Gunji T et al. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to cover wounds after colorectal endoscopic submucosal dissection (with video). Gastrointest Endosc 2014; 79: 151-155
• 8 Shinya N, Oka S, Miyabashita S et al. Improvement of the tissue-adhesive and sealing effect of fibrin sealant using polyglycolic acid felt. J Invest Surg 2009; 22: 383-389
• 9 Takeuchi J, Suzuki H, Murata M et al. Clinical evaluation of application of polyglycolic acid sheet and fibrin glue spray for partial glossectomy. J Oral Maxillofac Surg 2012; 71: e126-e131
• 10 Terasaka S, Iwasaki Y, Shinya N et al. Fibrin glue and polyglycolic acid nonwoven fabric as a biocompatible dural substitute. Neurosurgery 2006; 58: 134-139
• 11 Kawai H, Harada K, Ohta H et al. 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: 351-355
• 12 Hyashibe A, Sakamoto K, Shinbo M et al. New method for prevention of bile leakage after hepatic resection. J Surg Oncol 2006; 94: 57-60
• 13 Yamaguchi K, Miyagawa E, Takahashi H et al. Electron microscopic estimation of removal of parvovirus B19 (HPVB19) by nanofiltration with a novel filter membrane. J Membrane Sci 2007; 298: 99-109