Feasibility of a modified search, coagulation, and clipping method with and without the use of polyglycolic acid sheets and fibrin glue for preventing delayed bleeding after gastric endoscopic submucosal dissection

Abstract

Background: Methods have been developed for preventing delayed bleeding (DB) after gastric endoscopic submucosal dissection (GESD). However, none of the methods can completely prevent DB. We hypothesized that DB could be prevented by a modified search, coagulation, and clipping (MSCC) method for patients at low risk for DB and by combining the use of polyglycolic acid (PGA) sheets and fibrin glue with the MSCC method (PMSCC method) for patients at high risk for DB (antibleeding [ABI] strategy). This study assessed the technical feasibility of this novel strategy.Methods: We investigated 123 lesions in 121 consecutive patients who underwent GESD in Kushiro Rosai Hospital between April 2018 and January 2020. The decision for continuation or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment.Results: Oral antithrombotic agents were administered to 28 patients (22.8%). The en bloc R0 resection rate was 98.4%. The MSCC method and the PMSCC method for preventing DB were performed in 114 and 9 lesions, respectively. The median resection time of the MSCC method was 16 min, and the median speed (the resection area divided by the resection time) was 3.6 cm2/10 min. The median resection time of the PMSCC method was 59 min, and the median speed was 1.3 cm2/10 min. The only delayed procedural adverse event was DB in 1 (0.8%) of the 123 lesions.Conclusions: The ABI strategy is feasible for preventing DB both in patients at low risk and in those at high risk for DB after GESD, whereas the PMSCC method may be necessary for reduction of time.

Modified search, coagulation, and clipping with polyglycolic acid sheet and fibrin glue to reduce delayed bleeding risk after endoscopic submucosal dissection near the dentate line

“…However, empirically, lesions near the dentate line are considered to display less wall mobility, and endoscopic ligation is difficult. In post-gastric endoscopic submucosal dissection (ESD) ulcers, which are similarly difficult to close by endoscopic ligation, we have used a modified search, coagulation, and clipping (MSCC) method using polyglycolic acid sheets (PGA) and fibrin glue (PMSCC) for patients at high risk of delayed bleeding [2], and reported good results with no delayed bleeding among nine patients [3]. We therefore devised a new strategy using PMSCC for patients at high risk of delayed bleeding after colorectal ESD near the dentate line.…”