Introduction EMR / ESD of large lesions creates large mucosal defects and is associated with significant post-procedural bleeding. EndoclotTM is a topical hemostatic powder that rapidly absorbs water creating a high concentration of platelets, red blood cells and clotting factors – accelerating the natural coagulation cascade. Routine application of EndoclotTM to ESD or EMR defects is hypothesised to reduce the risk of significant post EMR/ESD bleeding.
Methods A prospective registry was set up to record all EMR / ESD procedures since 2006. Prophylactic use of EndoclotTM, following endoscopic resection of lesions >20 mm, to prevent delayed bleeding was introduced in June 2014. The bleeding rate since the introduction of this strategy was compared with the bleed rate of our historic cohort since 2006. Bleeding was defined as significant if it required: readmission, transfusion or further intervention. SPSS was used for statistical analysis of data.
Results Pre-Endoclot cohort: 496 patients underwent lower gastrointestinal EMR/ESD at our institution between 2006 and 2013 with a mean polyp size of 43 mm and 12% of these polyps were scarred due to previous intervention. Significant delayed bleeding was seen in 21/496 patients (4%). 264 patients underwent upper gastrointestinal EMR/ESD at our institution between 2006 and 2013. Significant delayed bleeding was seen in 9/264 patients (3%).
Endoclot cohort: 71 patients have undergone colonic EMR/ESD (mean polyp size 46 mm, 38% scarred) (Table 1). 61 patients have undergone upper gastrointestinal resection (mean lesion size 33 mm, 37% scarred).
There was 1 significant delayed bleed in the colonic group (1%) requiring further endoscopic therapy. There were 2 bleeds (3%) in the upper GI group, which were managed with further endoscopic therapy without the need for blood transfusion. There have been no complications related to EndoclotTM use. Device clogging was experienced in 5% of upper gastrointestinal cases and 15% of lower gastrointestinal cases.
Conclusion EndoclotTM shows promise in reducing the risks of delayed bleeding following endoscopic resection of large neoplastic lesions from the gastrointestinal tract. Our data demonstrates a 75% reduction in risk of delayed bleeding following EMR/ESD for large colonic polyps in a group with a significantly higher rate of scarring and therefore bleeding risk. A randomised controlled trial is required to clarify the role of routine use of EndoclotTM following EMR/ESD.
Disclosure of Interest None Declared
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