Efficacy of Surgicel® (Fibrillar) for preventing bleeding after endoscopic submucosal dissection for gastric epithelial tumors

Abstract

Objective Surgicel (Fibrillar), i.e. oxidized regenerated cellulose, is used to control oozing bleeding after surgery, but few studies have assessed its effect on complications after endoscopic treatment. The aim of this study was to evaluate the efficacy of Surgicel for preventing bleeding after endoscopic submucosal dissection (ESD) for gastric epithelial tumors. Methods From November 2012 to December 2013 patients scheduled for ESD of gastric epithelial tumors were prospectively enrolled in this study. Patients were assigned randomly to monotherapy with a proton pump inhibitor (PPI) (the MT group) or combination therapy with Surgicel and histamine‐2 receptor antagonist (H2RA) (the CT group) for preventing bleeding after ESD. Major bleeding rates and changes in hemoglobin at 1 and 7 days after ESD were evaluated. Results Among the 157 patients enrolled (111 men, 46 women), 78 were assigned to the MT group and 79 to the CT group; finally, 72 and 74 patients were included in the MT and CT groups. The major bleeding rate was lower in the CT group (6/74, 8.1%) than in the MT group (12/72, 16.7%), but the difference was not significant (P = 0.354). The change in hemoglobin was significantly less marked in the CT group than the MT group 1 day after ESD ([−6.2 ± 9.0] g/L vs [−8.9 ± 6.2] g/L, P = 0.045). Conclusions Combination therapy with Surgicel and an H2RA decreased the rate of bleeding similarly to PPI. Adding Surgicel to H2RA could be considered for patients with bleeding tendencies, or who require continuous antiplatelet therapy to prevent bleeding after ESD.

Bleeding after endoscopic submucosal dissection of gastric lesions

“…Surgicel (Fibrillar) (Johnson & Johnson, PlazaNew Brunswick, NJ, USA), an oxidized regenerated cellulose, and histamine 2 receptor antagonists (H 2 RA) can decrease the incidence of hemorrhage in the same way as PPIs. For patients at a high risk of hemorrhage, adding Surgicel to H 2 RA can be considered . For the closure of the artificial ulcer, the traditional clipping is technically difficult when the mucosal defect is large.…”

Endoscopic Delivery of Polymers Reduces Delayed Bleeding after Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

“…Grey diamond: Pooled estimate of effect size. Its width corresponds to its 95% CI [19,52,53,[55][56][57].…”

“…Of the total, 54 proved potentially relevant for full-text review. Of these, 31 articles on the management of ESD-induced ulcers via endoscopic closure (hemoclips, endoclips, endoloop + endoclips, detachable snare + clips, OTSC + through-the-scope clips [TTSC], overstitch suturing, handsewn suturing) [31][32][33][34][35][36][37][38][39][40][41][42], tissue shielding methods (PGA sheets-based) [10,[43][44][45][46][47][48][49], and hemostatic powder/gel spray [18,19,[50][51][52][53][54][55][56][57][58], matched the selection criteria and were included in the systematic review. The key characteristics of each included study appear in Table 1.…”

A novel self-assembled gel protects against endoscopic resection- induced colonic ulcers: a randomized clinical trial A novel gel that could promote ulcer healing

“…Researchers showed that large mucosal defects (> 21 mm in diameter) were more likely to bleed, which indicates that the risk of bleeding associated with ESD is signi cantly higher than that associated with EMR [26]. Usually, most post-ER bleeding episodes are successfully managed using endoscopic intervention; however, delayed diagnosis and treatment may be fatal in some cases [27]. Perforation may also be associated with fatal outcomes; intra-abdominal leakage of intestinal contents can cause secondary and serious complications such as peritonitis [28].…”