Endoscopy 2020; 52(S 01): S60
DOI: 10.1055/s-0040-1704189
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 16:30 – 18:00 Unlock en-bloc 2 Wicklow Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

POLYSACCHARIDE HEMOSTATIC POWDER TO PREVENT BLEEDING AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION: A PROSPECTIVE MULTICENTER RANDOMIZED CONTROLLED TRIAL

JC Park
1   Yonsei University College of Medicine, Internal Medicine, Seoul, Korea, Republic of
,
DH Jung
1   Yonsei University College of Medicine, Internal Medicine, Seoul, Korea, Republic of
,
CH Park
2   Hanyang University College of Medicine, Internal Medicine, Guri, Korea, Republic of
,
HS Moon
3   Chungnam National University College of Medicine, Internal Medicine, Daejeon, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Endoscopists have a chance to face an increasing number of patients with high risk of post-ESD bleeding (PEB) due to antithrombotic agents. In order to verify the efficacy for prevention method of PEB, we designed the first randomized controlled trial (RCT) on the efficacy of the hemostatic powder (HP) for the prevention of PEB.

Methods Patients who underwent ESD for gastric neoplasms with high risk of PEB were enrolled in this multicenter, prospective RCT. High risk patients were defined as patients with gastric neoplasms which resected specimen size was expected to be more than 40 mm and patients who took antithrombotic agents regularly. Patients were randomly assigned to one of two groups (HP group or control group). After ESD, the patients in the HP group was applied hemostatic powder on the ESD ulcer base.

Results Between May 2017 to September 2018, 143 patients were enrolled (73 in HP group and 70 in control group). The resected size of lesion was 48.9 mm in HP group and 46.9 mm in control group, respectively. En-bloc resection rate of all ESD was 99.3%. The complete resection and curative resection rate were 93.7% and 90.9%, respectively. PEB rate was 5% (4/73) in HP group and 7.1% (5/70) in control group, respectively (P = 0.742). Endoscopic hemostasis was achieved in all PEB cases, and the proportion of high-risk bleeding lesions (Forrest Ia, Ib or IIa) was 25.0% in HP group and 40.0% in control group. All PEB in the HP group occurred in late-phase. PEB rate in large resection cases (over 40mm) was 2.9% (2/69) in HP group and 7.2% (5/69) in control group (p=0.441).

Conclusions Although there is no significant difference of PEB between HP and control groups, there is a tendency to reduce the PEB ratio in large resected lesion and early phase in HP group.