Gastric Cancer

, Volume 21, Issue 4, pp 696–702 | Cite as

Efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued antithrombotic agents

  • Noboru Kawata
  • Hiroyuki Ono
  • Kohei Takizawa
  • Naomi Kakushima
  • Masaki Tanaka
  • Kimihiro Igarashi
  • Masao Yoshida
  • Yoshihiro Kishida
  • Tomohiro Iwai
  • Sayo Ito
  • Kenichiro Imai
  • Kinichi Hotta
  • Hirotoshi Ishiwatari
  • Hiroyuki Matsubayashi
Original Article



A novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking antithrombotic agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued antithrombotic agents.


One hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued antithrombotic agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared.


No significant differences were seen in the number and type of antithrombotic agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06–0.89). No adverse events were associated with the use of PGA sheets and fibrin glue.


The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued antithrombotic agents.


Endoscopic submucosal dissection Early gastric cancer Antithrombotic therapy Polyglycolic acid sheet Fibrin glue 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent or a substitute for such consent was obtained from all patients before inclusion in our study.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Noboru Kawata
    • 1
  • Hiroyuki Ono
    • 1
  • Kohei Takizawa
    • 1
  • Naomi Kakushima
    • 1
  • Masaki Tanaka
    • 1
  • Kimihiro Igarashi
    • 1
  • Masao Yoshida
    • 1
  • Yoshihiro Kishida
    • 1
  • Tomohiro Iwai
    • 1
  • Sayo Ito
    • 1
  • Kenichiro Imai
    • 1
  • Kinichi Hotta
    • 1
  • Hirotoshi Ishiwatari
    • 1
  • Hiroyuki Matsubayashi
    • 1
  1. 1.Division of EndoscopyShizuoka Cancer CenterNagaizumiJapan

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