Polysaccharide hemostatic system for hemostasis management in colorectal endoscopic mucosal resection

Abstract

A new polysaccharide hemostatic system (EndoClot(TM) ) was recently developed for bleeding control in gastrointestinal tract endoscopy; however, its efficacy and safety is not yet well established in colorectal endoscopic mucosal resection (EMR). The aim of the present study was to observe the bleeding control effect after EMR in the colorectum. EndoClot(TM) was applied immediately to mucosal defects after resection whether or not there was post-resection bleeding. Bleeding was monitored post-procedurally by clinical findings including positive stool occult blood test and by second-look endoscopy. Hemostasis, rebleeding rates and treatment-related complications were observed. In total, 82 patients were enrolled, totaling 181 lesions. Among them, 20 lesions in 18 cases showed bleeding immediately after the procedure. Among them, two lesions were treated by combined hot biopsy forceps, and complete hemostasis was achieved in all cases without surgery. It took 1.1 min (0.4-2.1) tocarry out hemostasis treatment. Rebleeding with positive stool test and colonoscopy recurred in three of 18 patients with immediate post-procedural bleeding. In patients without immediate post-procedural bleeding, three patients were confirmed with delayed bleeding. No major adverse events of treatment or procedure-related serious adverse events were reported during a 30-day follow up. Colonoscopy was done in selected patients at 30 days and full recovery of mucosal defect was achieved in all cases. Polysaccharide hemostatic system effectively achieves hemostasis in controlling and preventing EMR-related bleeding with the advantage of simple application; thus it might be a useful alternative in treating bleeding endoscopically.