Gastrointestinal hemorrhage caused by the direct invasion of a hepatocellular carcinoma successfully treated with polyglycolic acid sheet shielding

Abstract

Gastrointestinal hemorrhage caused by the direct invasion of a hepatocellular carcinoma successfully treated with polyglycolic acid sheet shielding ▶ Fig. 2 Endoscopic views showing: a a submucosal tumor with central ulceration in the lesser curvature of the stomach; b, c infiltrating irregular reddish-white tumor with partial necrosis, showing intermittent blood oozing. ▶ Fig. 1 Computed tomography scan of the abdomen showing a markedly enlarged hepatocellular carcinoma in the left lobe (arrowhead), approximately 10 cm in diameter, which was compressing the stomach (arrows).

Endoscopic shielding using oxidized regenerated cellulose after argon plasma coagulation under mandatory dual antiplatelet therapy

“…Apart from polyglycolic acid (PGA) sheets, another biocompatible, naturally absorbable hemostatic substance for endoscopic applications is oxidized regenerated cellulose, which is less expensive and more broadly available . Apart from endoscopic shielding for endoscopic resection procedures, there is an ever‐increasing set of clinical applications in interventional endoscopy reported, including perforation and/or fistula closure, difficult‐to‐treat bleeding situations, and—among others—stricture prevention following esophageal ESD procedures . However, argon plasma coagulation (APC), for which endoscopic shielding has not yet been reported, is by itself considered a low‐risk procedure in terms of bleeding in recent guidelines, however, clinical caution is mandatory in the presence of dual antiplatelet therapy (DAPT).…”