Preventing Hemorrhage After Endoscopic Submucosal Dissection Using Polysaccharide Hemostatic Materials

Summary

Here, we present a protocol for using polysaccharide hemostatic materials to manage hemorrhage after endoscopic submucosal dissection (ESD).

Abstract

Endoscopic submucosal dissection (ESD) is a minimally invasive procedure that is widely used for the treatment of early gastric cancer and certain submucosal tumors. ESD often results in large artificial ulcers, leading to a risk of intraoperative and postoperative bleeding, which is a significant complication. Traditional methods to address this bleeding include proton pump inhibitors (PPIs), local hemostatic sprays, hemostatic clips, electrocoagulation, etc. However, this research introduces polysaccharide-based materials as a novel hemostatic solution, demonstrating their effectiveness in preventing upper gastrointestinal tract bleeding associated with ESD. The results of our study, focusing on both gastric and esophageal lesions, suggest that the microporous polysaccharide hemostatic material is effective in preventing bleeding following upper gastrointestinal tract ESD procedures. The key benefits of polysaccharide hemostatic materials include biocompatibility, no immune risk, excellent absorbability, and fast hemostatic speed. Clinical results from the study indicate that patients treated with these materials did not experience delayed bleeding, and follow-up gastroscopy showed good wound healing without negative impacts on the artificial ulcer. This suggests that polysaccharide hemostatic materials are a safe and effective option for patients undergoing gastric ESD surgery.

Introduction

With the development of endoscopic technology, ESD has been widely used in the minimally invasive treatment of early gastric cancer and submucosal tumors¹. This technology can completely remove large areas of lesions and has a low residual and recurrence rate². The main complications of gastric ESD surgery include perforation, bleeding, infection, and stenosis³. Among them, delayed bleeding after ESD surgery is considered one of the most serious and challenging complications of ESD⁴. Despite the use of preventive measures like proton pump inhibitors (PPIs), intraoperative e....

Protocol

This study was approved by the Shanghai Civil Aviation Hospital Committee (Ethics Approval No: 2023-06), and written informed consent was obtained from all participants prior to their inclusion in the study.

1. Preoperative preparation

1. Confirm that the patient has fasted for 8 h before the procedure.
2. Administer intravenous fluids to prevent hypoglycemia and maintain electrolyte balance.
3. Set up for tracheal intubation to facilitate general anesthesia.
4. Give proton pump inhibitors 1 h prior to the surgery to mitigate bleeding risk.

2. Gastroscop....

Results

On May 2024, 5 patients undergoing esophageal and gastric mucosal ESD surgery received polysaccharide hemostatic materials for local hemostasis of wounds (Table 1). In this study, 1 g of microporous polysaccharide hemostatic material was uniformly applied to each ulcer. However, for ulcers located in the cardia, 2 g of the material was used, due to the abundant blood vessels in this region. Every esophageal and gastric mucosal lesion diagnosis was confirmed through pathological examination. None were con.......

Discussion

Although endoscopic submucosal dissection (ESD) is considered a relatively safe treatment method, it is not without potential risks and complications³. These include bleeding, perforation, infection, anesthesia-related risks, postoperative pain, etc³. Bleeding is a particularly significant concern, especially in cases involving large or deeply located tumors⁴. Postoperative bleeding is most likely to occur within 24 h after surgery, although it can a.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Argon electrode	ERBE Elektromedizin GmbH	20132-177
Digestive endoscopy argon plasma coagulation (APC) knife system	ERBE Elektromedizin GmbH	VIO200
Disposable high-frequency cutting knife	Micro-Tech (Nanjing) CO, Ltd	MK-T-2-195
Endoscopic therapy device	Fujifilm (China) Investment Co., Ltd	BL-7000
Gastroscope	Fujifilm (China) Investment Co., Ltd	EG-760CT
Hot biopsy forceps	Nanwei Medical Technology Co., Ltd	N/A
Petroleum jelly	Qingdao Jinqi Biotechnology Co., Ltd	N/A
Polysaccharide hemostatic powder	Jiangsu Deviceland Medical Devices Co., LTD	N/A
Powder dispenser	Jiangsu Deviceland Medical Devices Co., LTD	N/A