Clinical Endoscopy

Original Article

Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs: Hiroya Sakaguchi, Toshitatsu Takao, Yoshitaka Takegawa, Yuki Koga, Kazunori Yamanaka, Masataka Sagata, Shinwa Tanaka, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama; Clin Endosc 2021;54(1):64-72. Published online July 16, 2020; DOI: https://doi.org/10.5946/ce.2020.014

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Background
/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs.
Methods
PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared.
Results
With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm² and 0.32 (0.18–0.52) min/cm² with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm² and 0.50 (0.39–0.58) min/cm² (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups.
Conclusions
The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.

Citations

Citations to this article as recorded by

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International Journal of Biological Macromolecules.2025; 306: 141146. CrossRef
Endoscopic sealing hemostasis with polyglycolic acid sheet and fibrin glue as a novel endoscopic hemostatic technique: a report of three cases
Kai Korekawa, Atsushi Kunimitsu
Clinical Journal of Gastroenterology.2024; 17(4): 626. CrossRef
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Catalysts.2024; 14(12): 903. CrossRef
Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy
Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama
Clinical Endoscopy.2022; 55(1): 86. CrossRef
The importance of pH adjustment for preventing fibrin glue dissolution in the stomach: an in vitro study
Yoshitaka Takegawa, Toshitatsu Takao, Hiroya Sakaguchi, Tatsuya Nakai, Kazuhiro Takeo, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
Scientific Reports.2022;[Epub] CrossRef
A Novel Self-Assembled Gel for Gastric Endoscopic Submucosal Dissection-Induced Ulcer: A Preclinical Study in a Porcine Model
Meng Li, Haifeng Jin, Changpei Shi, Bin Lyu, Xiao Ying, Yuan Shi
Frontiers in Pharmacology.2021;[Epub] CrossRef

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Case Report

Endoscopic Management of Gastrointestinal Leaks and Perforation with Polyglycolic Acid Sheets: Sojung Han, Hyunsoo Chung, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee; Clin Endosc 2017;50(3):293-296. Published online March 8, 2017; DOI: https://doi.org/10.5946/ce.2016.121

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Gastrointestinal (GI) leakage, fistulae, and perforations can be serious and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. Here, we report two cases of endoscopic closure of a GI fistula and perforation using polyglycolic acid (PGA) sheets with fibrin glue. The first case is of an anastomotic leak detected after subtotal gastrectomy with gastroduodenostomy. After failed application of endoclips, a PGA sheet was applied, and the fistula was successfully closed. The second case was of a 15-mm large perforated gastric ulcer, which was also successfully closed with a PGA sheet. This is the first case report that PGA sheet was used for the treatment of overt perforation. The outcome of these cases suggest that endoscopic closure using PGA sheets can be considered as a useful alternative for the management of GI leakage, fistulae, and perforations.

Citations

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American Journal of Gastroenterology.2023; 118(5): 892. CrossRef
Large anastomotic leak: endoscopic treatment using combined fibrin glue and polyglycolic acid (PGA) sheets
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BMJ Case Reports.2021; 14(8): e240188. CrossRef
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Techniques in Gastrointestinal Endoscopy.2019; 21(2): 65. CrossRef
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Hideaki Kawabata, Yuji Okazaki, Naonori Inoue, Yukino Kawakatsu, Misuzu Hitomi, Masatoshi Miyata, Shigehiro Motoi
Endoscopy International Open.2018; 06(08): E994. CrossRef
Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor
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Case Reports in Gastroenterology.2018; 12(3): 679. CrossRef

8,689 View
231 Download
7 Web of Science
6 Crossref

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