Polyglycolic acid sheets decrease post-endoscopic submucosal dissection bleeding in early gastric cancer: A systematic review and meta-analysis.

Abstract

OBJECTIVE:

Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC). However, post-ESD bleeding remains a serious issue, particularly in patients treated with an antithrombotic agent or those have had a large mucosal resection (≥4 cm). Whether covering the ulcer bed induced by ESD with polyglycolic acid (PGA) sheets can prevent post-ESD bleeding remains to be questioned. Therefore, we performed a systematic review and meta-analysis to evaluate the effectiveness of PGA sheets on preventing post-ESD bleeding in patients with early gastric cancer (EGC) at a high risk of post-ESD bleeding.

METHODS:

PubMed, Cochrane Library and EMBASE databases were searched for studies on the effect of PGA sheets shielding on inpatients with EGC and at a high risk of bleeding using post-ESD bleeding rate as the primary outcome.

RESULTS:

Among the four included studies (212 lesions in the PGA sheet group and 208 in the control group), post-ESD bleeding rate was significantly lower in the PGA sheet group than in the control group (4.9% vs 13.7%, risk ratio [RR] 0.33, 95% confidence interval [CI] 0.18-0.72, P = 0.004). A subgroup analysis showed that the application of PGA sheets effectively reduced the post-ESD bleeding rate in patients receiving antithrombotic agents (5.5% vs 15.2%; RR 0.37, 95% CI 0.17-0.79, P = 0.01). Although the application of PGA sheets tended to decrease the post-ESD bleeding rate in patients who had undergone large mucosal resections, the difference was not significant (4.5% vs 9.6%; RR 0.52, 95% CI 0.15-1.78, P = 0.29).

CONCLUSIONS:

PGA sheets can effectively prevent post-ESD bleeding in patients receiving antithrombotic agents. Further studies are needed to confirm whether PGA sheets can decrease post-ESD bleeding in patients underwent large mucosal resection.

• Authors: De Feng Li, Feng Xiong, Zheng Lei Xu, Ding Guo Zhang, Jun Yao, Li Sheng Wang
• Journal: Journal of digestive diseases (J Dig Dis) Vol. 21 Issue 8 Pg. 437-444 (Aug 2020) ISSN: 1751-2980 [Electronic] Australia
• PMID: 32573104 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2020 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Chemical References

• Fibrinolytic Agents
• Polyglycolic Acid

Topics

• Aged
• Aged, 80 and over
• Endoscopic Mucosal Resection (adverse effects)
• Female
• Fibrinolytic Agents (adverse effects)
• Gastric Mucosa (surgery)
• Gastroscopy (adverse effects)
• Humans
• Male
• Middle Aged
• Polyglycolic Acid (administration & dosage)
• Postoperative Hemorrhage (prevention & control)
• Stomach Neoplasms (surgery)
• Treatment Outcome