Wafer paper and ring-mounted polyglycolic acid sheet method for shielding artificial gastric floor

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.

Keywords:

• Polyglycolic acid sheet
• delivery method
• wafer paper

Acknowledgement

The authors thank Mark Cleasby, PhD, of Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Ethical approval

The present study was approved by the Clinical Ethics Committee of Kagawa University Hospital (No. 2019-253) and that of each of the other institutions, and was conducted in accordance with the principles of the Declaration of Helsinki. The study is reported according to the STROBE checklist. All patients provided their written informed consent to undergo the procedures and participate in the study.

Declaration of interest

All authors have no conflicts of interest or financial ties to disclose.