Efficacy of local hemostatic agents after endoscopic submucosal dissection: a meta-analysis

Abstract Introduction: Topical hemostatic agents have been used to reduce bleeding rates after endoscopic submucosal dissection (ESD) for gastric cancer. However, to date, no review has summarized evidence on their efficacy. Material and methods: PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were searched for studies comparing bleeding rates after ESD with and without local hemostatic agents. Results: Eleven studies were included. The studies used polyglycolic acid (PGA) sheets and fibrin glue, fibrin glue, oxidized regenerated cellulose, polysaccharide hemostatic powder, or polyethylene oxide adhesive. Meta-analysis revealed a statistically significant reduction in the risk of delayed bleeding with the use of PGA sheets & fibrin glue (six studies; RR: 0.35 95% CI: 0.20, 0.63 p = 0.0005). However, meta-analysis of two studies showed no difference in the risk of bleeding based on the use of fibrin glue (RR: 0.44 95% CI: 0.03, 7.17 p = 0.56). Scarce data were available for the remaining hemostatic agents. Conclusion: A large number of different hemostatic agents have been used to reduce the risk of bleeding after ESD for gastric cancer. Observational studies indicate that the use of PGA with fibrin glue could reduce the risk of bleeding after ESD. However, evidence for other agents was too scarce to derive conclusions.

[1]  Rui Li,et al.  Propensity score matching analysis to evaluate efficacy of polyethylene oxide adhesive on preventing delayed bleeding after gastric endoscopic submucosal dissection , 2022, Scientific reports.

[2]  G. Tropeano,et al.  Early gastric cancer: A challenge in Western countries , 2022, World journal of gastroenterology.

[3]  Hongqun Liu,et al.  A narrative review of postoperative bleeding in patients with gastric cancer treated with endoscopic submucosal dissection. , 2021, Journal of gastrointestinal oncology.

[4]  H. Ono,et al.  Endoloop closure following gastric endoscopic submucosal dissection to prevent delayed bleeding in patients receiving antithrombotic therapy , 2021, Scandinavian journal of gastroenterology.

[5]  E. Mayo-Wilson,et al.  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews , 2021, BMJ.

[6]  Jie Wu,et al.  Global Patterns and Trends in Gastric Cancer Incidence Rates (1988-2012) and Predictions to 2030. , 2021, Gastroenterology.

[7]  T. Miyagishima,et al.  Feasibility of a modified search, coagulation, and clipping method with and without the use of polyglycolic acid sheets and fibrin glue for preventing delayed bleeding after gastric endoscopic submucosal dissection , 2020, BMC Gastroenterology.

[8]  D. Jung,et al.  Polysaccharide hemostatic powder to prevent bleeding after endoscopic submucosal dissection in high risk patients: a randomized controlled trial , 2020, Endoscopy.

[9]  I. Oda,et al.  Endoscopic Closure Utilizing Endoloop and Endoclips After Gastric Endoscopic Submucosal Dissection for Patients on Antithrombotic Therapy , 2020, Digestive Diseases and Sciences.

[10]  M. Nakagawa,et al.  Current evidence and issues of endoscopic submucosal dissection for gastric neoplasms during antithrombotic therapy , 2020, Clinical Journal of Gastroenterology.

[11]  Jun Yao,et al.  Polyglycolic acid sheets decrease post-endoscopic submucosal dissection bleeding in early gastric cancer: a systematic review and meta-analysis. , 2020, Journal of digestive diseases.

[12]  T. Matysiak-Budnik,et al.  Gastric Cancer: Where Are We Heading? , 2020, Digestive Diseases.

[13]  R. Shi,et al.  Bleeding after endoscopic submucosal dissection of gastric lesions , 2020, Journal of digestive diseases.

[14]  H. Ono,et al.  Endoscopic hand-suturing is feasible, safe, and might contribute in reducing bleeding risk after gastric endoscopic submucosal dissection: a multicenter pilot study (with video). , 2020, Gastrointestinal endoscopy.

[15]  Y. Ohkura,et al.  Utility of autologous fibrin glue and polyglycolic acid sheet for preventing delayed bleeding associated with antithrombotic therapy after gastric ESD , 2019, Endoscopy International Open.

[16]  J. Ji,et al.  Effectiveness of fibrin sealant as hemostatic technique in accelerating ESD-induced ulcer healing: a retrospective study , 2019, Surgical Endoscopy.

[17]  N. Yamamichi,et al.  Endoscopic tissue shielding to prevent bleeding after endoscopic submucosal dissection: a prospective multicenter randomized controlled trial , 2019, Endoscopy.

[18]  S. Hong,et al.  Efficacy of Surgicel® (Fibrillar) for preventing bleeding after endoscopic submucosal dissection for gastric epithelial tumors , 2018, Journal of digestive diseases.

[19]  H. Ono,et al.  Efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued antithrombotic agents , 2018, Gastric Cancer.

[20]  Chengfeng Wang,et al.  Long-Term Clinical Efficacy and Perioperative Safety of Endoscopic Submucosal Dissection versus Endoscopic Mucosal Resection for Early Gastric Cancer: An Updated Meta-Analysis , 2018, BioMed research international.

[21]  T. Masaki,et al.  Efficacy of innovative polyglycolic acid sheet device delivery station system: a randomized prospective study , 2018, Surgical Endoscopy.

[22]  Eun Hye Kim,et al.  Role of second‐look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection: A systematic review and meta‐analysis , 2017, Journal of gastroenterology and hepatology.

[23]  D. Libânio,et al.  Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis. , 2016, Gastrointestinal endoscopy.

[24]  O. Scatton,et al.  An update on topical haemostatic agents in liver surgery: systematic review and meta analysis , 2016, Journal of hepato-biliary-pancreatic sciences.

[25]  F. Liu,et al.  Fibrin Glue Spray as a Simple and Promising Method to Prevent Bleeding after Gastric Endoscopic Submucosal Dissection , 2016, Digestive Surgery.

[26]  H. Isomoto,et al.  Polyglycolic Acid Felt Sealing Method for Prevention of Bleeding Related to Endoscopic Submucosal Dissection in Patients Taking Antithrombotic Agents , 2016, Gastroenterology research and practice.

[27]  N. Ogasawara,et al.  Risk factors for bleeding evaluated using the Forrest classification in Japanese patients after endoscopic submucosal dissection for early gastric neoplasm , 2015, European journal of gastroenterology & hepatology.

[28]  N. Yamamichi,et al.  Polyglycolic acid sheets and fibrin glue decrease the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms (with video). , 2015, Gastrointestinal endoscopy.

[29]  T. Matsui,et al.  Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment , 2014, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[30]  P. Tugwell,et al.  The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses , 2014 .

[31]  D. Altman,et al.  Chapter 8: Assessing risk of bias in included studies , 2008 .

[32]  K Masuda,et al.  Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. , 1988, Gastrointestinal endoscopy.