Efficacy of hemostatic powder in preventing bleeding after gastric endoscopic submucosal dissection in high‐risk patients

Background and Aim The prevention of post‐endoscopic submucosal dissection (ESD) bleeding in high‐risk patients is an important problem. This study evaluated the efficacy of polysaccharide hemostatic powder in preventing post‐ESD bleeding in high‐risk patients. Methods Patients at high risk for post‐ESD bleeding were prospectively enrolled between December 2015 and July 2016. A high risk of post‐ESD bleeding was considered if the patients were taking antithrombotic agents or had undergone a large resection (specimen size ≥ 40 mm). The endpoints were Forrest classification of the post‐ESD ulcer on second‐look endoscopy 2 days after the procedure and bleeding rates within 48 h and at 4 weeks. Results Forty‐four patients underwent gastric ESD and treatment with hemostatic powder. Among them, 33 patients (70.5%) underwent large resection (≥ 40 mm) without antithrombotic therapy, and 13 patients (29.5%) received antithrombotic therapy. The mean resected specimen size was 55.3 ± 13.9 mm. The proportion of high‐risk delayed bleeding lesions (Forrest IIa) at second‐look endoscopy was 4.5% (2/44). The overall bleeding rate was 9.1% (4/44). There was no early bleeding event. The median (interquartile range) timing of bleeding after the procedure was 12.5 (interquartile range 10.3–15.5) days. The bleeding rate in the large resection (≥ 40 mm) group without antithrombotic therapy and the antithrombotic therapy group was 3.2% (1/33) and 23.1% (3/13), respectively. Conclusions Hemostatic powder may be a promising new simple and effective method to prevent early post‐ESD bleeding in high‐risk patients, especially for those with larger resection. (Clinical trial registration number: NCT02625792).