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

J Gastroenterol Hepatol. 2018 Mar;33(3):656-663. doi: 10.1111/jgh.13990.


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).

Keywords: adverse event; antithrombotic therapy; endoscopic submucosal dissection; hemostatic powder; high risk of bleeding; post-ESD bleeding.

MeSH terms

  • 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


  • Fibrinolytic Agents
  • Hemostatics
  • Polysaccharides
  • Powders

Associated data

  • ClinicalTrials.gov/NCT02625792