Feasibility of bioabsorbable polyglycolic acid sheet and fibrin glue therapy for ulcer sealing after gastric endoscopic submucosal dissection

Objectives: Combined therapy using a bioabsorbable polyglycolic acid sheet (BAPGAS) and fibrin glue (FG) has been employed to prevent postoperative perforation. More recently, this therapy has been applied to ulcers that develop after endoscopic submucosal dissection (ESD) for early digestive tract tumors. This study was performed to evaluate the sealing effect of this combined therapy on ulcers that develop after ESD for early gastric tumors. Methods: This study included nine patients with early gastric cancer or adenoma who were treated with ESD. Ulcers that developed after ESD were covered with BAPGAS and sealed with FG spray. To assess ulcer bleeding and healing status, endoscopy was performed on postoperative days 1, 7, 28, and 56. Results: On days 1 and 7, clots were observed in only two patients, and no bleeding occurred in any patient. As a result, endoscopic hemostasis was not required. In one patient, scar healing was achieved by day 28. By day 56, seven of the nine patients’ ulcers had reached the scar stage, and no bleeding was observed in any patient. Changes in hemoglobin levels 1 week after ESD were not significant (from 13.1 to 12.7 g/dL). The average BAPGAS covering time was approximately 40 minutes. No correlation was found between BAPGAS covering time and ESD procedure time, dissection time, or resected area. Conclusions: Combined therapy with BAPGAS and FG is a promising new treatment for preventing bleeding from artificial ulcers following ESD and may help avoid the need for additional endoscopic hemostasis.