Endoscopic shielding technique, a new method in therapeutic endoscopy

Bon, Ignacio; Bartolı́, Ramón; Lorenzo-Zúñiga, Vicente

doi:10.3748/wjg.v23.i21.3761

Cited by 10 publications

(9 citation statements)

References 18 publications

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“…Topical application of a coverage agent refers to the creation of a shield with a biocompatible medical device (tissue or hydrogel) with proven bioactive properties. Coverage of the eschar after endoscopic resection provides shielding protection to prevent delayed complications[ 9 ]. A comprehensive understanding of the pathogenic mechanisms of action involved is mandatory to address these challenges.…”

Section: Introductionmentioning

confidence: 99%

Prevention of late complications with coverage agents in endoscopic resection of colorectal lesions: Current landscape in gastrointestinal endoscopy

Lorenzo-Zúñiga

Bustamante-Balén²,

Pons-Beltrán

2021

WJG

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Endoscopic removal of large (≥ 20 mm) non-pedunculated colorectal lesions (LNPCLs) may result in major adverse events, such as delayed bleeding (DB) and delayed perforation (DP), despite closure of the mucosal defects with clips. Topical application of a coverage agent refers to the creation of a shield with a biocompatible medical device (tissue or hydrogel) with proven bioactive properties. Coverage of the eschar after endoscopic resection provides shielding protection to prevent delayed complications. The aim of the present review was to systematically collect and review the currently available literature regarding the prevention of DB and DP with coverage agents after endoscopic mucosal resection or endoscopic submucosal dissection of LNPCLs.

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Section: Introductionmentioning

confidence: 99%

Prevention of late complications with coverage agents in endoscopic resection of colorectal lesions: Current landscape in gastrointestinal endoscopy

Lorenzo-Zúñiga

Bustamante-Balén²,

Pons-Beltrán

2021

WJG

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“…These drugs have changed the way of treating IBD patients, but those situations represent unmet needs that require new treatment modalities to prolong the intervention-free period. An endoscopic shielding technique with hydrogels has been proposed by our group as a less invasive approach to reduce or postpone the need for surgical resection ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Development and Characterization of a New Endoscopic Drug-Eluting Platform With Proven Efficacy in Acute and Chronic Experimental Colitis

et al. 2020

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Background and Aims: Mucosal lesions refractory to biological treatments represent unmet needs in patients with inflammatory bowel disease (IBD) that require new treatment modalities. We developed and characterized a new endoscopic drug-eluting hydrogel (CoverGel) with proven efficacy in acute and chronic experimental colitis (EC) in rats. Methods: CoverGel was developed based on appropriate rheological, drug release, gelation, structural, and degradation property capacities to allow endoscopic application. Experimental colitis (EC) was induced by TNBS application in rats. In acute EC 40, rats were randomized in five groups (eight each): Sham, Control, CoverGel, CoverGel + Infliximab (IFX) and CoverGel + Vedolizumab (VDZ). In chronic EC, 12 rats were randomized in two groups (six each): IFX s.c. and CoverGel + IFX. Endoscopic, histological, and blood test were performed during follow-up to evaluate clinical success. Antibodies to IFX (ATIs) were evaluated in chronic EC animal study. Results: CoverGel is a biocompatible and bioadhesive reverse thermosensitive gelation hydrogel with a macroporous structure and drug release capacity. In acute EC animals treated with CoverGel + IFX or CoverGel + VDZ showed significantly clinical success (weight recovery, mucosal restoration, and bacterial translocation) as compared with controls and animals without a bioactive drug. In a chronic EC animal study, clinical efficacy was comparable in both groups. Levels of ATIs were significantly lower in animals treated with CoverGel + IFX vs. IFX s.c. (0.90 ± 0.06 µg/mL-c vs. 1.97 ± 0.66 µg/mL-c, p = 0.0025). Conclusions: CoverGel is an endoscopic vehicle to locally deliver biological drugs with proven efficacy in acute and chronic EC in rats and induce less immunogenicity reaction.

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“…These drugs have changed the way of treating IBD patients, but those situations represent unmet needs that require new treatment modalities to prolong the intervention-free period. Endoscopic shielding technique with hydrogels has been proposed by our group as a less invasive approach to reduce or postpone the need for surgical resection 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Development and Characterization of a New Endoscopic Drug Eluting Platform with Proven Efficacy in Acute and Chronic Experimental Colitis

Bon

Cano‐Sarabia

Ossa

et al. 2019

Preprint

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Brief summary: Direct drug administration through endoscopy opens new possibilities for therapeutic endoscopy in IBD. CoverGel is an endoscopic vehicle to locally deliver biological drugs with proven efficacy in acute and chronic experimental colitis in rats and inducing less immunogenicity reaction. ABSTRACTBackground&Aims: Mucosal lesions refractory to biological treatments represent unmet needs in patients with inflammatory bowel disease (IBD) that require new treatment modalities. We developed and characterized a new endoscopic drug-eluting hydrogel (CoverGel) with proven efficacy in acute and chronic experimental colitis (EC) in rats Methods: CoverGel was developed based on appropriate rheological, drug release, gelation, structural and degradation properties capacities to allow endoscopic application. Experimental colitis (EC) was induced by TNBS application in rats. In acute EC 40 rats were randomized in 5 groups (8 each): sham, control, CoverGel, CoverGel+Infliximab (IFX) andCoverGel+Vedolizumab (VDZ). In chronic EC 12 rats were randomized in 2 groups (6 each): IFX s.c and CoverGel+IFX. Endoscopic, histological and blood test were performed during follow-up to evaluate clinical success. Antibodies to IFX (ATIs) were evaluated in chronic EC animal study Results: CoverGel is a biocompatible and bioadhesive reverse thermo sensitive gelation hydrogel with macroporous structure and drug release capacity. In acute EC animals treated with CoverGel+IFX or CoverGel+VDZ showed significantly clinical success (weight recovery, mucosal restoration and bacterial translocation) as compare with controls and animals without bioactive drug. In chronic EC animal study, clinical efficacy was comparable in both groups. Levels of ATIs were significantly lower in animals treated with CoverGel+IFX vs. IFX s.c (0.90  0.06 g/mL-c vs. 1.97  0.66 g/mL-c, p=0.0025). Conclusions:CoverGel is an endoscopic vehicle to locally deliver biological drugs with proven efficacy in acute and chronic EC in rats and inducing less immunogenicity reaction.Nowadays we do not have any valid endoscopic treatment to IBD mucosal lesions in patients with refractory or loss of response to biological therapy. The purpose of the present study was to develop and characterize a new endoscopic drug-eluting platform and test its efficacy in acute and chronic experimental colitis in rats. METHODS Characterization of the drug-eluting platformWe have developed a new hydrogel (CoverGel) comprising specific amounts of hyaluronic acid (HA), methylcellulose (MC) and Poloxamer Pluronic-F127 (F127). This platform has been patented (PCT/EP2017/068876). The composition of CoverGel is based on the combination of different substances to create this solution, which can be prepared before the procedure.Our goal was to improve the beneficial effects of HA onto the colonic mucosa by adding different substances to increase biocompatibility, bioadhesibility and bioactive properties, and make it suitable to be administered through the endoscope's working channel. For this, we e...

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Endoscopic shielding technique, a new method in therapeutic endoscopy

Cited by 10 publications

References 18 publications

Prevention of late complications with coverage agents in endoscopic resection of colorectal lesions: Current landscape in gastrointestinal endoscopy

Prevention of late complications with coverage agents in endoscopic resection of colorectal lesions: Current landscape in gastrointestinal endoscopy

Development and Characterization of a New Endoscopic Drug-Eluting Platform With Proven Efficacy in Acute and Chronic Experimental Colitis

Development and Characterization of a New Endoscopic Drug Eluting Platform with Proven Efficacy in Acute and Chronic Experimental Colitis

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