Efficacy of hemostatic adhesive powder in preventing delayed bleeding after upper endoscopic submucosal dissection: A retrospective study

Background : Hemostatic adhesive powders have emerged as a novel strategy for managing and preventing post-endoscopic submucosal dissection (ESD) bleeding, promoting hemostasis, and potentially accelerating mucosal healing. However, their clinical benefits remain under investigation. Methods : Consecutive patients who underwent upper gastrointestinal (GI) ESD between 2014 and 2024 at a tertiary referral center, in which mucosal defects were either left unclosed or treated with a hemostatic adhesive powder, were included. The primary outcome was the rate of delayed bleeding. Outcomes were compared using the chi-square and Fisher exact tests and stepwise logistic regression. Continuous variables were reported as means with standard deviations (SDs). Results : The study included 226 patients, 40% of whom were female, with a mean age of 66.8 years (SD 12.5). The mean lesion diameter was 48.9 mm (SD 28.9). Most lesions were in the esophagus (n = 123, 54.4%), followed by the stomach (n = 90, 39.8%) and duodenum (n = 13, 5.8%). Overall, 97.3% (n = 220) of lesions were removed by en bloc resection, with a 77% curative resection rate. Fifteen percent (n = 34) of patients underwent prophylactic application of hemostatic adhesive following ESD, including 27 esophageal and 7 gastric defects. Delayed bleeding occurred in 9 (4%) patients. Chi-square analysis showed no statistically significant difference in bleeding rates between cohorts (χ2 = 0.378; P = 0.539). Univariate analysis likewise showed no significant association with bleeding (odds ratio 0.605, 95% confidence interval 0.120-3.046; P = 0.543). Conclusion : The use of hemostatic adhesive powder did not significantly affect delayed bleeding rates. Accordingly, upper GI ESD defects may not require prophylactic hemostatic intervention, which could reduce healthcare costs.