A self-assembling peptide reduces delayed bleeding after endoscopic submucosal dissection in the colorectum – a retrospective single center cohort study

Aims Endoscopic submucosal dissection (ESD) carries the risk of delayed bleeding. A novel self-assembling peptide (SAP) for hemostasis has shown promising results in reducing this risk after endoscopic resection, but there is only little data for the use after ESD. This retrospective trial aimed to compare the delayed bleeding rate (DBR) after ESD with and without application of a novel self-assembling peptide.

Methods All consecutive patients from 01.01.2018 to 31.07.2023 with endoscopic submucosal dissections with or without application of a self-assembling peptide (SAP) after resection and prophylactic hemostasis (coagulation, clipping) were retrospectively included in this study.

The primary outcome was the delayed bleeding rate (DBR), defined by significant bleeding (drop in hemoglobin>2 g/dL, hematemesis, ongoing hematochezia) within 30 days.

Results In total 225 patients (median age 67; 158 men) who underwent ESD (esophagus [n=49], stomach [n=40], duodenum [n=4], colorectum [n=132]) were included. The mean lesion size was 43.1 mm (SD: 21.5 mm) with a mean area of 10,46 cm² (SD: 6 cm²). In 108 patients (48%) the SAP was used after resection. The overall delayed bleeding rate was 10.4% (23/225), without SAP the DBR was 12.8% (15/117), after prophylactic application of the SAP it was 7.4% (8/108) (p=0,182).

Delayed bleeding rates in the esophagus were in total 0.5% (1/49), without SAP and with SAP 3.2% (1/31) and 0% (0/18), respectively (p=0,472). In the stomach DBR was 2.5% (5/40), without SAP 10% (2/20) and in the SAP-group 15% (3/20) (p=0.653). After ESDs in the duodenum no delayed bleedings occurred without using the SAP (0/4).

The delayed bleeding rate after ESD for lesions in the colorectum was 12.9% (17/136), after application of the SAP this was significantly lower (7.14%; 5/70) compared with not using the product (18.2; 12/66) (p=0.050). In logistic regression analysis these findings were independent of the number of clips used and the size of the lesion. No adverse events regarding the product occurred.

Conclusions The use of a self-assembling peptide after ESD may help to reduce delayed bleedings especially in the colorectum. It is easy to use and safe. These findings have to be further clarified by prospective randomized controlled trials.

Publication History

Article published online:
15 April 2024