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

Objective Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC). However, post‐ESD bleeding remains a serious issue, particularly in patients treated with an antithrombotic agent or those have had a large mucosal resection (≥4 cm). Whether covering the ulcer bed induced by ESD with polyglycolic acid (PGA) sheets can prevent post‐ESD bleeding remains to be questioned. Therefore, we performed a systematic review and meta‐analysis to evaluate the effectiveness of PGA sheets on preventing post‐ESD bleeding in patients with early gastric cancer (EGC) at a high risk of post‐ESD bleeding. Methods PubMed, Cochrane Library and EMBASE databases were searched for studies on the effect of PGA sheets shielding on inpatients with EGC and at a high risk of bleeding using post‐ESD bleeding rate as the primary outcome. Results Among the four included studies (212 lesions in the PGA sheet group and 208 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] 0.18‐0.72, P = 0.004). A subgroup analysis showed that the application of PGA sheets effectively reduced the post‐ESD bleeding rate in patients receiving antithrombotic agents (5.5% vs 15.2%; RR 0.37, 95% CI 0.17‐0.79, P = 0.01). Although the application of PGA sheets tended to decrease the post‐ESD bleeding rate in patients who had undergone large mucosal resections, the difference was not significant (4.5% vs 9.6%; RR 0.52, 95% CI 0.15‐1.78, P = 0.29). Conclusions PGA sheets can effectively prevent post‐ESD bleeding in patients receiving antithrombotic agents. Further studies are needed to confirm whether PGA sheets can decrease post‐ESD bleeding in patients underwent large mucosal resection.