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PGA sheets plus fibrin glue reduce delayed bleeding risk after gastric endoscopic submucosal dissectionFibrin Glue and PGA Sheets Reduce Bleeding After Gastric Surgery

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Key Takeaway
Note that adding PGA sheets to fibrin glue significantly reduces delayed bleeding risk after gastric ESD compared to standard care.

This meta-analysis synthesized data from 2,728 adult patients undergoing gastric endoscopic submucosal dissection (ESD) to evaluate the efficacy of fibrin glue (FG) and polyglycolic acid (PGA) sheets. The analysis compared these interventions against standard care for outcomes including delayed bleeding, overall bleeding, and procedural complications.

The meta-analysis found that the combination of PGA plus FG significantly reduced the risk of delayed bleeding (RR: 0.33; 95% CI: 0.17, 0.63; P < 0.001) and symptomatic bleeding (P = 0.009). In contrast, fibrin glue alone did not show a statistically significant reduction in delayed bleeding (P = 0.26). Overall bleeding was significantly reduced when using these agents compared to standard care (RR: 0.52; 95% CI: 0.29, 0.91; P = 0.02). No significant differences were observed for acute bleeding or procedural perforation.

A primary limitation of this meta-analysis is the inclusion of both randomized controlled trials and observational studies, which may affect the certainty of the results. Clinical application suggests that while the combination of PGA sheets and fibrin glue appears to reduce delayed hemorrhage after gastric ESD, fibrin glue alone does not consistently provide a statistically significant benefit.

Researchers analyzed data from 2,728 adult patients who underwent a specific type of stomach surgery called endoscopic submucosal dissection (ESD). The study looked at how using fibrin glue, either alone or combined with polyglycolic acid (PGA) sheets, affected bleeding risks after the procedure.

The results showed that using both fibrin glue and PGA sheets significantly reduced the risk of delayed bleeding and overall bleeding. However, when patients received only fibrin glue without the extra sheets, the reduction in delayed bleeding was not statistically significant. The study also found no significant differences in acute bleeding or the rate of procedural perforations between the groups.

Because this analysis included both randomized trials and observational studies, the results show a link rather than a direct cause. While the combination treatment shows promise for reducing complications like symptomatic bleeding, it is important to talk with a doctor about specific surgical plans.

What this means for you:
Combining fibrin glue with PGA sheets may reduce delayed bleeding after certain stomach procedures.

Common questions

Does fibrin glue alone reduce bleeding?

The study found that using fibrin glue alone did not show a statistically significant reduction in delayed bleeding. While it was compared to standard care, the specific benefit of just the glue without added sheets was not confirmed as significant.

What is the benefit of adding PGA sheets?

When fibrin glue was combined with polyglycolic acid (PGA) sheets, there was a significant reduction in both delayed bleeding and symptomatic bleeding. This combination showed a much stronger effect than using fibrin glue alone.

Are there risks like perforation?

The study reported no significant difference in the rates of procedural perforation or acute bleeding between the different treatment groups. These specific complications did not vary significantly based on whether the patients received the combined treatment or standard care.

Study Details

Study typeMeta analysis
Sample sizen = 2,728
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BACKGROUND: Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric neoplasms with low lymph node metastasis risk but is associated with notable bleeding complications, especially in high-risk patients. This study aims to evaluate the effectiveness of fibrin glue (FG) based strategies, with or without polyglycolic acid (PGA) sheets, in reducing postoperative hemorrhage. METHODS: We performed a systematic search of PubMed, Scopus, and the Web of Science from inception to December 2025. We included randomized controlled trials and observational studies comparing FG or FG plus PGA sheets versus standard care in adult gastric ESD patients. The primary outcome was delayed bleeding. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Thirteen studies involving an analytical cohort of 2,728 patients were included. The meta-analysis demonstrated that the intervention significantly reduced the risk of delayed bleeding (RR: 0.49; 95% CI: 0.28, 0.84; P = 0.01) and overall bleeding (RR: 0.52; 95% CI: 0.29, 0.91; P = 0.02) compared to standard care. Subgroup analysis revealed that the benefit was primarily driven by the combination of PGA sheets and FG (RR: 0.33; 95% CI: 0.17, 0.63; P < 0.001), while FG alone did not show a statistically significant reduction (RR: 0.62; P = 0.26). Similarly, symptomatic bleeding was significantly reduced only in the PGA + FG subgroup (RR: 0.25; P = 0.009). No significant differences were observed regarding acute bleeding (RR: 0.90; P = 0.81) or procedural perforation (RR: 1.09; P = 0.87). CONCLUSION: The combined application of PGA sheets and fibrin glue significantly reduces delayed hemorrhage after gastric ESD, likely due to a dual mechanism of mechanical shielding and biological stabilization. Fibrin glue alone does not consistently confer a protective benefit.
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