Endoscopic tissue shielding to prevent bleeding after endoscopic submucosal dissection: a prospective multicenter randomized controlled trial

• DOI: 10.1055/a-0860-5280
• Publication Date: 2019-03-25T15:16:43Z
• Authors: Yosuke Kataoka; Yosuke Tsuji; Kingo Hirasawa; Kengo Takimoto; Tomonori Wada; Satoshi Mochizuki; Ken Ohata; Yoshiki Sakaguchi; Keiko Niimi; Satoshi Ono; Shinya Kodashima; Nobutake Yamamichi; Mitsuhiro Fujishiro; Kazuhiko Koike
• Keywords: Male; Endoscopic Mucosal Resection; Fibrin Tissue Adhesive; Postoperative Hemorrhage; Endoscopy, Gastrointestinal; Hemostatics; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Stomach Neoplasms; Humans; Female; Prospective Studies; Aged; Follow-Up Studies

Abstract Background Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Recent reports have described the efficacy of the endoscopic shielding method with polyglycolic acid (PGA) sheets and fibrin glue for the prevention of adverse events after ESD. The aim of the present study was to investigate whether the PGA shielding method provides additional benefit in preventing post-ESD bleeding compared with standard care. Methods This was a prospective, multicenter, randomized controlled trial. Patients at high risk of post-ESD bleeding were enrolled in the study. Before ESD, patients were randomized to either the PGA group or the control group. After completing ESD in the PGA group, PGA sheets were placed onto the ulcer floor and adhered with fibrin glue. The primary end point was the post-ESD bleeding rate. Results 140 eligible patients were enrolled from September 2014 to September 2016, and 137 were included in the intention-to-treat analysis (67 in the PGA group and 70 in the control group). Post-ESD bleeding occurred in three patients (4.5 %) in the PGA group and in four patients (5.7 %) in the control group; there was no significant difference between the two groups (P > 0.99). Post-ESD bleeding tended to occur later in the control group than in the PGA group (median 12.5 days [range 8 – 14] vs. 2 days [range 0 – 7], respectively). Conclusion The PGA shielding method did not demonstrate a significant effect on the prevention of post-ESD bleeding.