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Efficacy of polyglycolic acid sheeting with fibrin glue for perforations related to gastrointestinal endoscopic procedures: a multicenter retrospective cohort study

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Abstract

Objectives

Gastrointestinal (GI) perforations are one of the major adverse events of endoscopic procedures. Polyglycolic acid (PGA) sheets with fibrin glue have been reported to close GI perforations. However, its clinical outcome has not yet been fully investigated; thus, we conducted a multicenter retrospective observational study to assess the efficacy of PGA sheeting for GI perforation.

Methods

The medical records of patients who underwent PGA sheeting for endoscopic GI perforations between April 2013 and March 2018 in 18 Japanese institutions were retrospectively analyzed. PGA sheeting was applied when the clip closure was challenging or failed to use. Perforations were filled with one or several pieces of PGA sheets followed by fibrin glue application through an endoscopic catheter. Nasal or percutaneous drainage and endoscopic clipping were applied as appropriate. Clinical outcomes after PGA sheeting for intraoperative or delayed perforations were separately evaluated.

Results

There were 66 intraoperative and 24 delayed perforation cases. In intraoperative cases, successful closure was attained in 60 cases (91%). The median period from the first sheeting to diet resumption was 6 days (interquartile range [IQR], 4–8.8 days). Large perforation size (≥ 10 mm) and duodenal location showed marginal significant relationship to higher closure failure of intraoperative perforations. In delayed perforation cases, all cases had successful closure. The median period from the first sheeting to diet resumption was 10 days (IQR, 6–37.8 days). No adverse events related to PGA sheeting occurred.

Conclusion

Endoscopic PGA sheeting could be a therapeutic option for GI perforations related to GI endoscopic procedures.

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References

  1. Minami S, Gotoda T, Ono H, Oda I, Hamanaka H (2006) Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 63:596–601

    Article  Google Scholar 

  2. Ono H, Takizawa K, Kakushima N, Tanaka M, Kawata N (2015) Application of polyglycolic acid sheets for delayed perforation after endoscopic submucosal dissection of early gastric cancer. Endoscopy 47 Suppl 1 UCTN:E18–19

  3. Takimoto K, Hagiwara A (2016) Filling and shielding for postoperative gastric perforations of endoscopic submucosal dissection using polyglycolic acid sheets and fibrin glue. Endosc Int open 4:E661-664

    Article  Google Scholar 

  4. Kawai H, Harada K, Ohta H, Tokushima T, Oka S (2012) Prevention of alveolar air leakage after video-assisted thoracic surgery: comparison of the efficacy of methods involving the use of fibrin glue. Thorac Cardiovasc Surg 60:351–355

    Article  Google Scholar 

  5. Sugawara T, Itoh Y, Hirano Y, Higashiyama N, Shimada Y, Kinouchi H, Mizoi K (2005) Novel dural closure technique using polyglactin acid sheet prevents cerebrospinal fluid leakage after spinal surgery. Neurosurgery 57(4):290–294

    PubMed  Google Scholar 

  6. Takimoto K, Toyonaga T, Matsuyama K (2012) Endoscopic tissue shielding to prevent delayed perforation associated with endoscopic submucosal dissection for duodenal neoplasms. Endoscopy 44 Suppl 2 UCTN:E414–415

  7. Takimoto K, Imai Y, Matsuyama K (2014) Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to prevent delayed perforation after duodenal endoscopic submucosal dissection. Digestive Endosc: Off J Japan Gastroenterol Endosc Society 26(Suppl 2):46–49

    Article  Google Scholar 

  8. Ono S, Tsuji Y, Fujishiro M, Kodashima S, Yamamichi N, Koike K (2014) An effective technique for delivery of polyglycolic acid sheet after endoscopic submucosal dissection of the esophagus: the clip and pull method. Endoscopy 46 Suppl 1 UCTN:E44–45

  9. Tsuji Y, Ohata K, Gunji T, Shozushima M, Hamanaka J, Ohno A, Ito T, Yamamichi N, Fujishiro M, Matsuhashi N, Koike K (2014) Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to cover wounds after colorectal endoscopic submucosal dissection (with video). Gastrointest Endosc 79:151–155

    Article  Google Scholar 

  10. Sakaguchi Y, Tsuji Y, Yamamichi N, Fujishiro M, Koike K (2016) Successful closure of a large perforation during colorectal endoscopic submucosal dissection by application of polyglycolic acid sheets and fibrin glue. Gastrointest Endosc 84:374–375

    Article  Google Scholar 

  11. Tsuji Y, Fujishiro M, Kodashima S, Ono S, Niimi K, Mochizuki S, Asada-Hirayama I, Matsuda R, Minatsuki C, Nakayama C, Takahashi Y, Sakaguchi Y, Yamamichi N, Koike K (2015) Polyglycolic acid sheets and fibrin glue decrease the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms (with video). Gastrointest Endosc 81:906–912

    Article  Google Scholar 

  12. Kawata N, Ono H, Takizawa K, Kakushima N, Tanaka M, Igarashi K, Yoshida M, Kishida Y, Iwai T, Ito S, Imai K, Hotta K, Ishiwatari H, Matsubayashi H (2018) Efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued antithrombotic agents. Gastric Cancer: Off J Int Gastric Cancer Assoc Japanese Gastric Cancer Assoc 21:696–702

    Article  CAS  Google Scholar 

  13. Hatamori H, Yoshio T, Tokai Y, Namikawa K, Yoshimizu S, Horiuchi Y, Tsuchida T, Ishiyama A, Hirasawa T, Kanamori J, Okamura A, Imamura Y, Watanabe M, Fujisaki J (2021) Efficacy of endoscopic filling with polyglycolic acid sheets and fibrin glue for anastomotic leak after esophageal cancer surgery: identification of an optimal technique. Esophagus 18(3):529–536

    Article  Google Scholar 

  14. Haito-Chavez Y, Law JK, Kratt T, Arezzo A, Verra M, Morino M, Sharaiha RZ, Poley JW, Kahaleh M, Thompson CC, Ryan MB, Choksi N, Elmunzer BJ, Gosain S, Goldberg EM, Modayil RJ, Stavropoulos SN, Schembre DB, DiMaio CJ, Chandrasekhara V, Hasan MK, Varadarajulu S, Hawes R, Gomez V, Woodward TA, Rubel-Cohen S, Fluxa F, Vleggaar FP, Akshintala VS, Raju GS, Khashab MA (2014) International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 80:610–622

    Article  Google Scholar 

  15. Ono H, Tanaka M, Takizawa K, Kakushima N, Kawata N, Imai K, Hotta K, Matsubayashi H (2015) Utility of the over-the-scope-clip system for treating a large esophageal perforation. Esophagus 12:336–339

    Article  Google Scholar 

  16. John A, Chowdhury SD, Kurien RT, David D, Dutta AK, Simon EG, Abraham V, Joseph AJ, Samarasam I (2020) Self-expanding metal stent in esophageal perforations and anastomotic leaks. Indian J Gastroenterol: official J Indian Society of Gastroenterol 39:445–449

    Article  Google Scholar 

  17. Endo M, Inomata M, Terui T, Oana S, Kudara N, Obara H, Hashimoto Y (2004) New endoscopic technique to close large mucosal defects after endoscopic mucosal resection in patients with gastric mucosal tumors. Digestive Endosc: Off J Japan Gastroenterol Endosc Society 16:372–375

    Article  Google Scholar 

  18. Ye LP, Yu Z, Mao XL, Zhu LH, Zhou XB (2014) Endoscopic full-thickness resection with defect closure using clips and an endoloop for gastric subepithelial tumors arising from the muscularis propria. Surg Endosc 28:1978–1983

    Article  Google Scholar 

  19. Zhang Y, Wang X, Xiong G, Qian Y, Wang H, Liu L, Miao L, Fan Z (2014) Complete defect closure of gastric submucosal tumors with purse-string sutures. Surg Endosc 28:1844–1851

    Article  Google Scholar 

  20. Kantsevoy SV, Bitner M, Mitrakov AA, Thuluvath PJ (2014) Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc 79:503–507

    Article  Google Scholar 

  21. Li CH, Bair MJ, Chang WH, Shih SC, Lin SC, Yeh CY (2009) Predictive model for length of hospital stay of patients surviving surgery for perforated peptic ulcer. Journal of the Formosan Medical Association = Taiwan yi zhi 108:644–652

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Funding

No funding was received.

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Authors and Affiliations

  1. Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Kengo Takimoto & Yoshiko Nakano

  2. Department of Gastroenterology, Uji Tokushukai Medical Center, Kyoto, Japan

    Kengo Takimoto

  3. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

    Noriko Matsuura, Noboru Hanaoka & Yoji Takeuchi

  4. Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan

    Yosuke Tsuji

  5. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

    Kohei Takizawa & Hiroyuki Ono

  6. Department of Gastroenterology, International Clinical Cancer Research Center, Kobe University Hospital, Kobe, Japan

    Yoshinori Morita

  7. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshinori Morita

  8. Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan

    Yasuaki Nagami

  9. Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan

    Kingo Hirasawa

  10. Department of Gastroenterology, Gifu University Hospital, Gifu, Japan

    Hiroshi Araki

  11. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan

    Naoyuki Yamaguchi

  12. Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan

    Hiroyuki Aoyagi

  13. Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan

    Tamotsu Matsuhashi

  14. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

    Toshiro Iizuka

  15. Department of Gastroenterology, Shinonoi General Hospital, Nagano, Japan

    Hisanobu Saegusa

  16. Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan

    Kenji Yamazaki

  17. Department of Internal Medicine, Shikoku Cancer Center, Ehime, Japan

    Shinichiro Hori

  18. Department of Gastroenterology, Chugoku Central Hospital, Fukuyama, Japan

    Tomohiko Mannami

  19. Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan

    Hirohito Mori & Hideki Kobara

  20. Department of Gastroenterology, Uji Tokushukai Medical Center, 145, Ishibashi, Makishima-cho, Uji-city, Kyoto, Japan

    Kengo Takimoto

Authors
  1. Kengo Takimoto
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  2. Noriko Matsuura
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  3. Yoshiko Nakano
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  4. Yosuke Tsuji
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  7. Yasuaki Nagami
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  19. Hirohito Mori
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  20. Hideki Kobara
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  21. Yoji Takeuchi
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  22. Hiroyuki Ono
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Consortia

Polyglycolic Acid Study Group

Contributions

KT, NM, YN, YT, YT, KT, YM, YN, KH, HA, NY, HA, TM, TI, HS, KY, HS, TM, HN, and HM collected the data. KT, NM, YN, YT, YT, KT, YM, YN, KH, HA, NY, HA, TM, TI, HS, KY, HS, TM, HN, HK, YT and HO assisted with data analysis and interpretation. YT planned and conducted the study. KT drafted the manuscript. All authors participated in the preparation of the report and approved the final version.

Corresponding author

Correspondence to Kengo Takimoto.

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Disclosures

Dr. Yosuke Tsuji had research grant from GUNZE, received study material (Neoveil), and study drug (Beriplast) from GUNZE and CSL Behring, respectively. Dr. Shinichiro Hori received honoraria for lectures from Fujifilm, Kaneka Medix, and Japan Gastroenterological Endoscopy Society. Dr. Yoji Takeuchi received honoraria for lectures from Olympus, Boston Scientific Japan, Daiichi-Sankyo, Miyarisan Pharmaceutical, Asuka Pharmaceutical, AstraZeneca, EA Pharma, Zeria Pharmaceutical, Fujifilm, Kaneka Medix, Kyorin Pharmaceutical, and Japan Gastroenterological Endoscopy Society. Hiroyuki Ono received honoraria for lectures from Olympus, AstraZeneca, EA Pharma, and Daiichi-Sankyo. Drs. Kengo Takimoto, Noriko Matsuura, Yoshiko Nakano, Kohei Takizawa, Yoshinori Morita, Yasuaki Nagami, Kingo Hirasawa, Hiroshi Araki, Naoyuki Yamaguchi, Hiroyuki Aoyagi, Tamotsu Matsuhashi, Toshiro Iizuka, Hisanobu Saegusa, Kenji Yamazaki, Tomohiko Mannami, Noboru Hanaoka, Hirohito Mori, and Hideki Kobara have no conflict of interest or financial ties to disclose.

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Takimoto, K., Matsuura, N., Nakano, Y. et al. Efficacy of polyglycolic acid sheeting with fibrin glue for perforations related to gastrointestinal endoscopic procedures: a multicenter retrospective cohort study. Surg Endosc 36, 5084–5093 (2022). https://doi.org/10.1007/s00464-021-08873-5

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