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

Kikuchi

Nagami

et al. 2019

Digestive Endoscopy

Prevention therapy is recommended for lesions >1/2 of the esophageal circumference. Locoregional steroid injection is recommended for lesions >1/2–3/4 of the esophageal circumference and oral steroids are recommended for lesions >1/2 of the subtotal circumference. For lesions of the entire circumference, oral steroid combined with injection steroid is considered. Endoscopic balloon dilatation (EBD) is the first choice of treatment for stricture after esophageal endoscopic submucosal dissection (ESD). Radical incision and cutting or self‐expandable metallic stent can be considered for refractory stricture after EBD. In case of intraoperative perforation during esophageal ESD, endoscopic clip closure should be initially attempted. Surgery is considered for treatment of delayed perforation. Current standard practice for prevention of delayed bleeding after gastric ESD includes prophylactic coagulation of vessels on post‐ESD ulcers and giving proton pump inhibitors. Chronic kidney disease stage 4 or 5, multiple antithrombotic drug use, anticoagulant use, and heparin bridging therapy are high‐risk factors for delayed bleeding after gastric ESD. Intraoperative perforation during gastric ESD is initially managed by endoscopic clip closure. If endoscopic clip closure is difficult, other methods such as over‐the‐scope clip (OTSC), polyglycolic acid (PGA) sheet shielding etc. are attempted. Delayed perforation usually requires surgical intervention, but endoscopic closure by OTSC or PGA sheet may be considered. Resection of three‐quarters of the circumference is a risk factor for stenosis after gastric ESD. Giving prophylactic local steroid injection and/or oral steroid is reported, but effectiveness has not been fully verified as has been done for esophageal stricture. The main management method for gastric stenosis is EBD but it may cause perforation.

Section: New Endoscopic Approaches For Prevention Of Delayed Bleedingmentioning

confidence: 93%

Section: Adverse Events Related To Gastric Esdmentioning

confidence: 98%

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Kikuchi

Nagami

et al. 2019

Digestive Endoscopy

“…Artificial ulcers after ESD can be shielded using polyglycolic acid tablets and fibrin glue, which is expected to reduce the risk of postoperative hemorrhage . Kawata et al reported that polyglycolic acid tablets and fibrin glue could decrease the rate of postoperative hemorrhage. In addition, a study of medical adhesives found that patients given a medical adhesive had a lower rate of post‐ESD hemorrhage than the control group (0% vs 4.88%).…”

Section: Precautions Against Bleeding After Gastric Esdmentioning

confidence: 99%

Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

Endoscopic submucosal dissection (ESD) is generally used to treat gastric mucosal and submucosal lesions. Nevertheless, ESD is more difficult and complicated to perform than a traditional endoscopic mucosal resection, which can increase the incidence of various complications including hemorrhage, perforation and infection. Hemorrhage is a major post‐ESD complication. Prevention and early diagnosis of post‐ESD bleeding for gastric lesions are closely associated with the efficacy and safety of the operation. Many studies have reported the risks of and the preventative measures for hemorrhage after gastric ESD, but there remain some issues to be solved. We thus reviewed the risk factors, precautions and treatments for hemorrhage after ESD of gastric lesions.

“…Closure of endoscopic resection induced ulcers of the stomach with endoscopic clips has been performed for many years, 23 but recently, methods of covering the ulcers using polyglycolic acids sheets (PGA sheets) and fibrin glue have also been reported. 24,25 In addition, endoscopic handsuturing for defect closure using special forceps for grasping a needle with thread has also been developed, 26 and it is expected to be used in clinical practice in the near future. In the Core Sessions, three research presentations on the prevention of delayed bleeding were reported (94th, two; 96th, one).…”

Section: Current Status Of Therapeutic Endoscopy For Gastric Lesionsmentioning

confidence: 99%

Innovative therapeutic endoscopy in the upper gastrointestinal tract: Review of Japan Gastroenterological Endoscopic Society Core Sessions

Yahagi

et al. 2020

Digestive Endoscopy

Self Cite

Workshops on "Innovative Therapeutic Endoscopy" for upper gastrointestinal tract diseases were held four times as the Japan Gastroenterological Endoscopic Society (JGES) Core Sessions at the 93rd to 96th Biannual Meetings of the JGES. A total of 48 research presentations (including two invited lectures) were reported, and various discussions were held on these topics. When the research presentations were categorized according to the therapeutic procedure, endoscopic submucosal dissection (ESD) was the most frequent with 28 presentations (58.3%), followed by laparoscopy endoscopy cooperative surgery (LECS) with six presentations (12.5%). When the research presentations were classified by the target organ of the therapeutic procedures, the duodenum was the most frequent with 26 presentations (54.1%), followed by the stomach with 13 presentations (27.1%). The most important issue was the establishment of a safe and reliable endoscopic resection method for duodenal lesions. Issues related to gastric ESD were establishing an efficient traction method and a method to prevent post‐ESD bleeding in high‐risk patients. Other important issues were establishment of an efficient traction method and methods of preventing delayed bleeding in high‐risk patients who undergo gastric ESD, expansion of indications for minimally invasive treatment using LECS for gastric cancer, the development of endoscopic full‐thickness resection (EFTR) for gastric submucosal tumors (SMTs), and improvement of per‐oral endoscopic myotomy (POEM) for esophageal achalasia and per‐oral endoscopic tumor resection (POET) for esophageal SMTs. Through the JGES Core Sessions, it is expected that the minimally invasive treatments using endoscopes developed in Japan will be further advanced.