Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan.
Gastric Cancer. 2018 Jul;21(4):696-702. doi: 10.1007/s10120-018-0791-4. Epub 2018 Jan 22.
A novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking antithrombotic agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued antithrombotic agents.
One hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued antithrombotic agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared.
No significant differences were seen in the number and type of antithrombotic agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06-0.89). No adverse events were associated with the use of PGA sheets and fibrin glue.
The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued antithrombotic agents.
由于接受抗血栓药物治疗的患者数量增加，因此需要一种新的方法来预防胃内镜黏膜下剥离（ESD）术后出血。本研究旨在评估聚乙二醇酸（PGA）片和纤维蛋白胶覆盖法用于预防继续接受抗血栓药物治疗的患者接受 ESD 诱导性溃疡后发生 ESD 后出血的疗效和安全性。
2014 年 4 月至 2015 年 9 月期间，连续 84 例接受继续抗血栓药物治疗的患者共进行了 105 例胃肿瘤 ESD。将患者分为两组，覆盖组（38 例患者的 52 个病变；在 ESD 中使用 PGA 片和纤维蛋白胶作为覆盖方法）和对照组（46 例患者的 53 个病变；仅 ESD），比较两组 ESD 后出血率。
两组患者抗血栓药物的种类和数量、病变部位、中位手术时间和中位切除标本大小无统计学差异。所有病例均完成 ESD，术中无不可控制的出血。覆盖组和对照组 ESD 后出血发生率分别为 5.8%（3/52）和 20.8%（11/53）。两组间 ESD 后出血率差异有统计学意义（P=0.04；优势比，0.23；95%置信区间，0.06-0.89）。PGA 片和纤维蛋白胶的使用无不良反应。
PGA 片和纤维蛋白胶覆盖法有可能降低继续接受抗血栓药物治疗的患者 ESD 后出血的发生率。
