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

Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California90001, USA. Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China.

J Dig Dis. 2020
Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC). However, post-ESD bleeding remains a serious issue particularly in patients continued antithrombotic agent treatment or undergone a large mucosal resection (>4 cm). It has been suggested that ulcer bed induced by ESD covered with polyglycolic acid (PGA) sheets can prevent post-ESD bleeding. However, the effectiveness of this procedure has been questioned. To this end, Pubmed, Cochrane library and Embase databases were searched for studies on the effects of PGA sheets shielding on inpatients with EGC and high risk bleeding using post-ESD bleeding rate as the primary outcome. Among the four included studies with 212 lesions in the PGA sheets group and 208 lesions 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) 0.16-0.69, P = 0.003). Subgroup analysis showed application of PGA sheets effectively reduced the post-ESD bleeding rate in patients receiving antithrombotic agents (5.5% vs. 14.5%, RR 0.39, 95% CI 0.18-0.83, P = 0.01). However, although application of PGA sheets tended to decrease post-ESD bleeding rate in patients who underwent large mucosal resections, the difference was not significantly different (3.0% vs. 9.6%, RR 0.43; 95% CI 0.08-2.23, P = 0.31) and need to be further confirmed.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine