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.
Highlights
Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer
We have developed a new safety measure for gastric ESD in patients receiving antithrombotic therapy, who have an increased risk of postoperative bleeding, whereby autologous blood is collected from the patient before gastric ESD to develop an autologous fibrin glue that is used in combination with polyglycolic acid (PGA) sheets to cover the post-ESD
The Japan Gastroenterological Endoscopy Society has recently revised its guidelines for the management of patients undergoing GI endoscopy under antithrombotic therapy [17]
Summary
Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer. ESD can be performed safely, but some procedural problems still need to be addressed. Intraoperative and postoperative bleeding is a serious problem in ESD for gastrointestinal (GI) lesions. Owing to technological advances in endoscopic devices and techniques, factors associated with intraoperative blood are being addressed, reducing the number of patients who cannot be treated because of intraoperative bleeding and those requiring transfusion [1, 2]. Postoperative bleeding remains a problem [3, 4]. Because of the frequent preventive and therapeutic use of antithrombotic drugs in patients with a history of myocardial infarction or stroke, it is important to develop new safety measures for patients receiving antithrombotic therapy [5, 6]
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