PTH-018 Endoclot Prophylaxis Following Complex Endoscopic Resection of Gastrointestinal Neoplasia: No Need to Bleed

IntroductionEMR / 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.MethodsA 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.ResultsPre-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).Abstract PTH-018 Table 1Colonic ER OutcomesMean Lesion Size (mm)Scarring %Delayed Bleeding %Pre-Endoclot n = 49643124Post-Endoclot n = 7146381P-valueNS