title: Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to cover wounds after colorectal endoscopic submucosal dissection (with video).
abstract: BACKGROUND
  Colorectal endoscopic submucosal dissection (ESD) has made it possible to resect large specimens in an en bloc fashion. However, this can lead to postoperative adverse events, such as perforation and bleeding. Prevention of adverse events after colorectal ESD is therefore an important goal.
  
  
  OBJECTIVE
  To evaluate the utility of a shielding method using polyglycolic acid (PGA) sheets and fibrin glue to manage ulcers after colorectal ESD.
  
  
  METHODS
  Prospective, single-arm, pilot study.
  
  
  METHODS
  Single tertiary care center for colorectal ESD in Japan.
  
  
  METHODS
  Ten patients with 10 colorectal tumors scheduled for ESD were enrolled between September and November 2012.
  
  
  METHODS
  Just after ESD, we placed PGA sheets on the mucosal defect with biopsy forceps. After the whole defect was covered, we sprayed fibrin glue through a special double-lumen spraying tube. We sprayed fibrinogen through 1 lumen and then thrombin through the other lumen.
  
  
  METHODS
  Success rate, mean procedure time, and adverse events associated with the covering technique and the persistence of PGA sheets at follow-up colonoscopy.
  
  
  RESULTS
  All 10 tumors were successfully resected. Mean tumor size was 39.7 ± 15.2 mm. All mucosal defects were successfully covered with PGA sheets. Mean procedure time was 18.7 ± 15.9 minutes. No procedure-related adverse events occurred. Upon colonoscopy 9 to 12 days after ESD, the PGA sheets were still fixed on the whole defect in 8 patients.
  
  
  CONCLUSIONS
  Small sample size.
  
  
  CONCLUSIONS
  Our technique, which uses PGA sheets and fibrin glue, appears to shield mucosal defects, and it may be effective in reducing postoperative adverse events.
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ohata
authors.affiliation: Center for Preventive Medicine, NTT Medical Center Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Gunji
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
authors.forename: Meiko
authors.initials: M
authors.lastname: Shozushima
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hamanaka
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ohno
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsuhashi
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010865:Pilot Projects; D011100:Polyglycolic Acid / Q000627:therapeutic use*; D011446:Prospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use*; D058106:Wound Closure Techniques / Q000295:instrumentation
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D011100:Polyglycolic Acid
keywords: ESD; PGA; endoscopic submucosal dissection; polyglycolic acid