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Efficacy of hemostatic powder in preventing bleeding after gastric endoscopic submucosal dissection in high-risk patients.

 Kyu Yeon Hahn  ;  Jun Chul Park  ;  Yong Kang Lee  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
 Journal of Gastroenterology and Hepatology, Vol.33(3) : 656-663, 2018 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Aged ; Blood Loss, Surgical/prevention & control* ; Female ; Fibrinolytic Agents/adverse effects ; Gastric Mucosa/surgery* ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/prevention & control* ; Gastroscopy* ; Hemostasis, Surgical/methods* ; Hemostatics/administration & dosage* ; Humans ; Male ; Middle Aged ; Polysaccharides/administration & dosage* ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control* ; Powders ; Prospective Studies ; Risk ; Second-Look Surgery ; Time Factors
adverse event ; antithrombotic therapy ; endoscopic submucosal dissection ; hemostatic powder ; high risk of bleeding ; post-ESD bleeding
BACKGROUND AND AIM: The prevention of post-endoscopic submucosal dissection (ESD) bleeding in high-risk patients is an important problem. This study evaluated the efficacy of polysaccharide hemostatic powder in preventing post-ESD bleeding in high-risk patients. METHODS: Patients at high risk for post-ESD bleeding were prospectively enrolled between December 2015 and July 2016. A high risk of post-ESD bleeding was considered if the patients were taking antithrombotic agents or had undergone a large resection (specimen size ≥ 40 mm). The endpoints were Forrest classification of the post-ESD ulcer on second-look endoscopy 2 days after the procedure and bleeding rates within 48 h and at 4 weeks. RESULTS: Forty-four patients underwent gastric ESD and treatment with hemostatic powder. Among them, 33 patients (70.5%) underwent large resection (≥ 40 mm) without antithrombotic therapy, and 13 patients (29.5%) received antithrombotic therapy. The mean resected specimen size was 55.3 ± 13.9 mm. The proportion of high-risk delayed bleeding lesions (Forrest IIa) at second-look endoscopy was 4.5% (2/44). The overall bleeding rate was 9.1% (4/44). There was no early bleeding event. The median (interquartile range) timing of bleeding after the procedure was 12.5 (interquartile range 10.3-15.5) days. The bleeding rate in the large resection (≥ 40 mm) group without antithrombotic therapy and the antithrombotic therapy group was 3.2% (1/33) and 23.1% (3/13), respectively. CONCLUSIONS: Hemostatic powder may be a promising new simple and effective method to prevent early post-ESD bleeding in high-risk patients, especially for those with larger resection. (Clinical trial registration number: NCT02625792).
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Kang(이용강)
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
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