Does Hemostatic Powder Lessen Bleeding After Endoscopic Submucosal Dissection?

Bleeding after endoscopic submucosal dissection (ESD) is one of the most common adverse events, but the risk of post-ESD bleeding varies, depending on antiplatelet or anticoagulation use, location of the resection, and lesion size. Various techniques have been attempted to minimize bleeding, including clipping and suturing, which can be technically challenging and time-consuming. Polysaccharide hemostatic powder (PHP), indicated for hemostasis in acute gastrointestinal bleeding, is easy to apply and has been used to decrease bleeding after ESD. This study is the first randomized controlled trial to determine whether PHP can effectively prevent post-ESD bleeding in high-risk patients (using antithrombotic agents and expected lesion resection size >40 mm). 

A total of 143 patients were enrolled in the study between May 2017 and September 2018 and randomized to receive PHP (n=73) or no further therapy (control group; n=70). Bleeding rates after ESD were similar in both groups: 5.5% in the PHP group versus 7.1% in the control group (P=.74). However, there was no bleeding within 7 days after ESD in the PHP group. Continued antithrombotic use was an independent risk factor for post-ESD bleeding. Excluding patients who continued to take antithrombotics during ESD (n=129), according to subgroup analysis, the trend of post-ESD bleeding was lower in the PHP group than in the control group (0% vs 6.3%; P=.06).