Background/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs. Methods: PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared. Results: With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm2 and 0.32 (0.18–0.52) min/cm2 with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm2 and 0.50 (0.39–0.58) min/cm2 (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups. Conclusions The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.

At our institution, various herbal medicines have been prescribed under the supervision of a herbal medicine supervisor for a wide range of clinical conditions in children with pediatric surgical diseases. At present, we continue to prescribe herbal medicines even in the absence of a herbal medicine supervisor. The aim of study is to continue and improve herbal medicines in pediatric surgery. A questionnaire survey was conducted among doctors prescribing herbal medicines in our department, and 14 doctors responded. All doctors agreed on their realization of the efficacy of herbal medicines and their willingness to study herbal medicines. Almost doctors obtained information on herbal medicine from the literature and decided on prescriptions based on the name of the disease and the symptoms. This survey showed that many doctors are aware of the effectiveness of herbal medicines and they prescribe herbal medicines to some extent in their own departments. As a result of this survey, three doctors from our department have received training in outpatient herbal medicine. Investigation of current problems through a fixed-point questionnaire survey would help to recognize the need for herbal medicine treatment in each department.