International Journal of Gastrointestinal Intervention · Published 2025-09-19 · DOI 10.18528/ijgii250059
Background : Hemostatic adhesive powders have emerged as a novel strategy for managing and preventing post-endoscopic submucosal dissection (ESD) bleeding, promoting hemostasis, and potentially accelerating mucosal healing. However, their clinical benefits remain under investigation. Methods : Consecutive patients who underwent upper gastrointestinal (GI) ESD between 2014 and 2024 at a tertiary referral center, in which mucosal defects were either left unclosed or treated with a hemostatic adhesive powder, were included. The primary outcome was the rate of delayed bleeding. Outcomes were compared using the chi-square and Fisher exact tests and stepwise logistic regression. Continuous variables were reported as means with standard deviations (SDs). Results : The study included 226 patients, 40% of whom were female, with a mean age of 66.8 years (SD 12.5). The mean lesion diameter was 48.9 mm (SD 28.9). Most lesions were in the esophagus (n = 123, 54.4%), followed by the stomach (n = 90, 39.8%) and duodenum (n = 13, 5.8%). Overall, 97.3% (n = 220) of lesions were removed by en bloc resection, with a 77% curative resection rate. Fifteen percent (n = 34) of patients underwent prophylactic application of hemostatic adhesive following ESD, including 27 esophageal and 7 gastric defects. Delayed bleeding occurred in 9 (4%) patients. Chi-square analysis showed no statistically significant difference in bleeding rates between cohorts (χ2 = 0.378; P = 0.539). Univariate analysis likewise showed no significant association with bleeding (odds ratio 0.605, 95% confidence interval 0.120-3.046; P = 0.543). Conclusion : The use of hemostatic adhesive powder did not significantly affect delayed bleeding rates. Accordingly, upper GI ESD defects may not require prophylactic hemostatic intervention, which could reduce healthcare costs.
Abstract from DOAJ. Public domain (CC0 1.0).
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