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Efficacy of polyglycolic acid sheeting with fibrin glue for perforations related to gastrointestinal endoscopic procedures: a multicenter retrospective cohort study.

Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. k-takimoto-kengo-1209-1209@y8.dion.ne.jp. Department of Gastroenterology, Uji Tokushukai Medical Center, Kyoto, Japan. k-takimoto-kengo-1209-1209@y8.dion.ne.jp. Department of Gastroenterology, Uji Tokushukai Medical Center, 145, Ishibashi, Makishima-cho, Uji-city, Kyoto, Japan. k-takimoto-kengo-1209-1209@y8.dion.ne.jp. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan. Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. Department of Gastroenterology, International Clinical Cancer Research Center, Kobe University Hospital, Kobe, Japan. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan. Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan. Department of Gastroenterology, Gifu University Hospital, Gifu, Japan. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan. Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan. Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. Department of Gastroenterology, Shinonoi General Hospital, Nagano, Japan. Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan. Department of Internal Medicine, Shikoku Cancer Center, Ehime, Japan. Department of Gastroenterology, Chugoku Central Hospital, Fukuyama, Japan. Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.

Surgical endoscopy. 2022;(7):5084-5093
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Abstract

OBJECTIVES Gastrointestinal (GI) perforations are one of the major adverse events of endoscopic procedures. Polyglycolic acid (PGA) sheets with fibrin glue have been reported to close GI perforations. However, its clinical outcome has not yet been fully investigated; thus, we conducted a multicenter retrospective observational study to assess the efficacy of PGA sheeting for GI perforation. METHODS The medical records of patients who underwent PGA sheeting for endoscopic GI perforations between April 2013 and March 2018 in 18 Japanese institutions were retrospectively analyzed. PGA sheeting was applied when the clip closure was challenging or failed to use. Perforations were filled with one or several pieces of PGA sheets followed by fibrin glue application through an endoscopic catheter. Nasal or percutaneous drainage and endoscopic clipping were applied as appropriate. Clinical outcomes after PGA sheeting for intraoperative or delayed perforations were separately evaluated. RESULTS There were 66 intraoperative and 24 delayed perforation cases. In intraoperative cases, successful closure was attained in 60 cases (91%). The median period from the first sheeting to diet resumption was 6 days (interquartile range [IQR], 4-8.8 days). Large perforation size (≥ 10 mm) and duodenal location showed marginal significant relationship to higher closure failure of intraoperative perforations. In delayed perforation cases, all cases had successful closure. The median period from the first sheeting to diet resumption was 10 days (IQR, 6-37.8 days). No adverse events related to PGA sheeting occurred. CONCLUSION Endoscopic PGA sheeting could be a therapeutic option for GI perforations related to GI endoscopic procedures.

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Publication Type : Multicenter Study ; Observational Study

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