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Endoscopy 2015; 47(04): 336-340
DOI: 10.1055/s-0034-1390787
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Polyglycolic acid sheets with fibrin glue can prevent esophageal stricture after endoscopic submucosal dissection

Yoshiki Sakaguchi
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Yosuke Tsuji
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
2   Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Satoshi Ono
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Itaru Saito
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Yosuke Kataoka
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Yu Takahashi
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Chiemi Nakayama
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Satoki Shichijo
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Rie Matsuda
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Chihiro Minatsuki
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Itsuko Asada-Hirayama
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Keiko Niimi
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
3   Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Shinya Kodashima
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Nobutake Yamamichi
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Mitsuhiro Fujishiro
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
2   Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Kazuhiko Koike
1   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 14 May 2014

accepted after revision 02 September 2014

Publication Date:
14 October 2014 (online)

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Background and study aims: Suitable techniques for the prevention of stricture formation after esophageal endoscopic submucosal dissection (ESD) are still lacking. We investigated the efficacy of polyglycolic acid (PGA) sheets with fibrin glue to prevent post-ESD stricture.

Patients and methods: We conducted a pilot study on a total of eight consecutive patients who underwent esophageal ESD that left a mucosal defect of more than three-quarters of the esophageal circumference. PGA sheets were attached to the defect with fibrin glue immediately after the completion of ESD. The primary endpoint was the incidence of post-ESD stricture. The secondary endpoints were the number of sessions of endoscopic balloon dilation (EBD) required to resolve any stricture and the rate of complications.

Results: There were no adverse events related to the use of PGA sheets and fibrin glue. Post-ESD stricture occurred in 37.5 % of the subjects and 0.8 ± 1.2 sessions of EBD were required.

Conclusion: The use of PGA sheets and fibrin glue after esophageal ESD is a novel method that radically decreases the incidence of esophageal stricture and the number of EBD sessions subsequently required.

University Hospital Medical Network Clinical Trial Registry (UMIN000011058).

 

  • References

  • 1 Ono S, Fujishiro M, Niimi K et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy 2009; 41: 661-665
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Ezoe Y, Muto M, Horimatsu T et al. Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 2011; 45: 222-227
    CrossrefPubMedGoogle Scholar
  • 3 Hashimoto S, Kobayashi M, Takeuchi M et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 2011; 74: 1389-1393
    CrossrefPubMedGoogle Scholar
  • 4 Yamaguchi N, Isomoto H, Nakayama T et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 2011; 73: 1115-1121
    CrossrefPubMedGoogle Scholar
  • 5 Hanaoka N, Ishihara R, Takeuchi Y et al. Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 2012; 44: 1007-1011
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Yamashina T, Uedo N, Fujii M et al. Delayed perforation after intralesional triamcinolone injection for esophageal stricture following endoscopic submucosal dissection. Endoscopy 2013; 45 (Suppl. 02) E92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Ishida T, Morita Y, Hoshi N et al. Disseminated nocardiosis during systemic steroid therapy for the prevention of esophageal stricture after endoscopic submucosal dissection. Dig Endosc [Epub ahead of print 05/2014; DOI: 2910.111/den.12317].
    PubMedGoogle Scholar
  • 8 Shinozaki T, Hayashi R, Ebihara M et al. Mucosal defect repair with a polyglycolic acid sheet. Jpn J Clin Oncol 2013; 43: 33-36
    CrossrefPubMedGoogle Scholar
  • 9 Middleton JC, Tipton AJ. Synthetic biodegradable polymers as orthopedic devices. Biomaterials 2000; 21: 2335-2346
    CrossrefPubMedGoogle Scholar
  • 10 Tsuji Y, Ohata K, Gunji T et al. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to cover wounds after colorectal endoscopic submucosal dissection (with video). Gastrointest Endosc 2014; 79: 151-155
    CrossrefPubMedGoogle Scholar
  • 11 Takimoto K, Toyonaga T, Matsuyama K. Endoscopic tissue shielding to prevent delayed perforation associated with endoscopic submucosal dissection for duodenal neoplasms. Endoscopy 2012; 44: E414-E415
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Ono S, Fujishiro M, Koike K. Endoscopic submucosal dissection for superficial esophageal neoplasms. World J Gastrointest Endosc 2012; 4: 162-166
    CrossrefPubMedGoogle Scholar
  • 13 Ono S, Tsuji Y, Fujishiro M et al. An effective technique for delivery of polyglycolic acid sheet after endoscopic submucosal dissection of the esophagus: the clip and pull method. Endoscopy 2014; 46: E44-E45
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Petersen B, Barkun A, Carpenter S et al. Tissue adhesives and fibrin glues. Gastrointest Endosc 2004; 60: 327-333
    CrossrefPubMedGoogle Scholar
  • 15 Ohki T, Yamato M, Okano T et al. Regenerative medicine: tissue-engineered cell sheet for the prevention of post-esophageal ESD stricture. Gastrointest Endosc Clin N Am 2014; 24: 273-281
    CrossrefPubMedGoogle Scholar