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Kobayashi N, Kobara H, Nishiyama N, Fujihara S, Kozuka K, Tada N, Matsui T, Chiyo T, Takata T, Fujita K, Tani J, Yachida T, Okano K, Nakano D, Nishiyama A, Mori H, Masaki T. Wafer paper and ring-mounted polyglycolic acid sheet method for shielding artificial gastric floor. MINIM INVASIV THER 2022; 31:548-555. [PMID: 33463391 DOI: 10.1080/13645706.2020.1871370] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The management of postoperative bleeding, after gastric endoscopic submucosal dissection (ESD), has become particularly important because of the recent increase in antithrombotic use. Endoscopic shielding with polyglycolic acid (PGA) sheets has been shown to be effective. However, shrinkage and early displacement of the sheet remain challenges. This study aimed to determine the efficacy and safety of our developed method, named wafer paper and ring-mounted PGA sheet (WaRP). MATERIAL AND METHODS Twenty-four patients with antithrombotic uptake who underwent the WaRP method following gastric ESD were retrospectively examined. This involved the delivery of a PGA sheet wrapped in wafer paper with ring-thread, and its fixation on the gastric floor using hemoclips. The primary outcome was the technical success rate of the WaRP, and several secondary outcomes were evaluated. RESULTS The technical success rate of WaRP was 100%. The procedure lasted a mean of 10.5 min (SD 6.7 min). The prevalence of complete retention at follow-up endoscopy was 83.3% (20/24). There were no WaRP-associated complications, but post-ESD hemorrhage occurred in two patients undergoing hemodialysis (8.3%). CONCLUSIONS The WaRP method is a simple and reliable means of PGA sheet delivery and placement that reduces the incidence of post-ESD hemorrhage.
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Affiliation(s)
- Nobuya Kobayashi
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Hideki Kobara
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Noriko Nishiyama
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Shintaro Fujihara
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Kazuhiro Kozuka
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Naoya Tada
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Takanori Matsui
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Taiga Chiyo
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Tadayuki Takata
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Koji Fujita
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Joji Tani
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Tatsuo Yachida
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Keiichi Okano
- Gastroenterological Surgery, Kagawa University, Kita, Japan
| | - Daisuke Nakano
- Pharmacology, Faculty of Medicine, Kagawa University, Kita, Japan
| | - Akira Nishiyama
- Pharmacology, Faculty of Medicine, Kagawa University, Kita, Japan
| | - Hirohito Mori
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Tsutomu Masaki
- Departments of Gastroenterology and Neurology, Kagawa University, Kita, Japan
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