Efficacy and safety of a novel Adhesive Haemostatic Polymer in the prevention of delayed bleeding following advanced endoscopic resection

Aims Delayed bleeding is a recognised complication following Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) of large precancerous polyps or early gastrointestinal neoplasia. Recently, topical haemostatic agents have been utilised as a therapeutic strategy to prevent bleeding. We adopted a novel topical haemostatic agent that consists of biocompatible, non-pyrogenic and starch derived polysaccharides with a recently altered adhesive polymer formulation. The aim of our study was to assess the safety and efficacy of this new topical haemostat in preventing delayed bleeding.

Methods A retrospective analysis of prospectively collected data was performed on patients who underwent advanced endoscopic resection between March and November 2024 and received the novel haemostat. Indications included polyps proximal to the splenic flexure>20mm resected with EMR with electrocautery and polyps distal to the splenic flexure>20 mm and resected with EMR or ESD in patients at high risk for delayed bleeding. In the duodenum polyps>10mm resected with EMR or any ampullectomy were considered. Indications in the oesophagus and stomach included any lesions>10 mm, resected with EMR or ESD in patients with high risk of delayed bleeding. Delayed bleeding was defined as clinically evident gastrointestinal bleeding that occurred up to 14 days post procedure which resulted in an emergency department presentation or required a blood transfusion or repeat intervention.

Results The novel haemostat was administered following the resection of 31 lesions in 30 patients. 60% were male with mean age of 65 years. 8 patients (27%) were taking either antiplatelets or anticoagulation. 14 (45%) resections were in the colon or rectum, 9 (29%) in the oesophagus, 3 (10%) in the duodenum and 5 (16%) in the stomach. EMR was the most utilised resection technique. Mean lesion size was 26 mm. There were two cases (6.7%) of delayed post-polypectomy bleeding reported. One patient developed delayed bleeding post EMR of a gastric neuroendocrine lesion. The second patient was on Clopidogrel and Warfarin which were re-commenced 48 hours post procedure and presented 10 days post EMR of a 25mm polyp in the descending colon. The novel haemostat appears to be safe with no noted adverse effects related to its administration.

Conclusions In our cohort, a novel haemostatic polymer with increased adhesive properties was safe and effective in prevention of bleeding after advanced endoscopic resection of high-risk lesions. One of the disadvantages of topical agents may be the duration of efficacy with the highest efficacy in the first 48 hours. The new adhesive formulation is expected to provide increased tissue adherence and therefore extended haemostasis. Our study is limited due to its single centre, retrospective nature with small sample size; larger multi-centre studies are anticipated.

Publication History

Article published online:
27 March 2025