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Effectiveness of fibrin sealant as hemostatic technique in accelerating ESD-induced ulcer healing: a retrospective study

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Abstract

Objectives

Healing of gastric endoscopic submucosal dissection (ESD)-induced ulcer is critical for patient recovery. During ESD treatment, submucosal incisions are made with an electrosurgical knife to accomplish en bloc resections of superficial lesions. Nevertheless, excess electrocoagulation may decrease the blood supply of ESD-induced ulcer and delay the ulcer healing. The aim of this retrospective study was to evaluate the effectiveness of conservative electrocoagulation followed by porcine fibrin sealant (FS) as a wound microvessels-protective hemostatic technique in promoting the healing of ESD-induced ulcer.

Methods

A total of 332 patients with early gastric cancer (EGCs), or gastric precancerous lesion and gastric adenoma were retrospectively analyzed. Propensity score matching was used to compensate for the differences in age, gender, tumor location, resected specimen area, and pathology. One-month ulcer healing rates and delayed bleeding were compared between two matched groups (combined hemostats group and electrocautery group).

Results

A total of 115 matched pairs were created after propensity score matching. There was no difference in tumor location, specimen surface area, tumor differentiation and invasion depth between groups. The completed healing rate 1 month after ESD was 44.3% in combined hemostats group and 30.4% in electrocautery group (P = 0.004). There was no difference in delayed massive bleeding rate between two groups (P = 0.300). In addition, based on the multivariate regression analysis for ulcer healing rate, the use of FS (OR, 0.348, 95% CI 0.196 − 0.617, P = 0.000) and larger specimen size (OR, 2.640, 95% CI 2.015–3.458, P = 0.000) were associated with nonhealing ulcer 1 month after ESD.

Conclusion

Applying conservative electrocoagulation followed by porcine FS as a wound microvessels-protective hemostatic technique can promote ESD-induced ulcer healing without increasing delayed bleeding.

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Abbreviations

ESD:

Endoscopic submucosal dissection

FS:

Porcine fibrin sealant

EGC:

Early gastric cancer

PGA:

Polyglycolic acid

PPI:

Proton pump inhibitor

D:

Differentiated gastric cancer

U:

Undifferentiated gastric cancer

M:

Intra-mucosal carcinoma

SM1:

< 500 micron from the muscularis mucosae

SM2:

500 micron from the muscularis mucosae

Lower:

Lower third of the stomach

Middle:

Middle third of the stomach

Upper:

Upper third of the stomach

PSM:

Propensity score matching

SD:

Standard deviation

IQR:

Interquartile range

OR:

Odd ratio

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Correspondence to Jia-Fu Ji.

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Disclosures

Drs. Jing Wang, Qi Wu, Yan Yan, Shi-Jie Li, Peng Yuan, Chang-Qi Cao, Dong-Feng Niu, Zi-Yu Li, Zhao-De Bu and Jia-Fu Ji have no conflicts of interest or financial ties to disclose.

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Wang, J., Wu, Q., Yan, Y. et al. Effectiveness of fibrin sealant as hemostatic technique in accelerating ESD-induced ulcer healing: a retrospective study. Surg Endosc 34, 1191–1199 (2020). https://doi.org/10.1007/s00464-019-06872-1

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Keywords

  • Porcine fibrin sealant
  • Ulcer
  • Healing
  • Endoscopic submucosal dissection
  • ESD
  • Electrocoagulation