Brief Article
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World J Gastroenterol. May 7, 2013; 19(17): 2704-2708
Published online May 7, 2013. doi: 10.3748/wjg.v19.i17.2704
Effects of medical adhesives in prevention of complications after endoscopic submucosal dissection
Yi Zhang, Ying Chen, Chun-Ying Qu, Min Zhou, Qian-Wen Ni, Lei-Ming Xu
Yi Zhang, Ying Chen, Chun-Ying Qu, Min Zhou, Qian-Wen Ni, Lei-Ming Xu, Department of Digestive Endoscopy, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China
Yi Zhang, Ying Chen, Chun-Ying Qu, Min Zhou, Qian-Wen Ni, Lei-Ming Xu, Shanghai Key Laboratory of Pediatric Digestion and Nutrition, Shanghai 200092, China
Author contributions: Zhang Y and Xu LM designed research; Qu CY, Zhou M and Chen Y contributed new reagents/analytic tools; Ni QW and Zhang Y analyzed data; Zhang Y and Xu LM wrote the paper.
Supported by Shanghai Key Laboratory of Pediatric Digestion and Nutrition, No. 11DZ2260500 and NO. 2010009
Correspondence to: Dr. Lei-Ming Xu, Department of Digestive Endoscopy, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, No. 1665 Kongjiang Road, Shanghai 200092, China. leiming.xu@yahoo.com.cn
Telephone: +86-21-65790000 Fax: +86-21-65790000
Received: September 21, 2012
Revised: January 8, 2013
Accepted: February 5, 2013
Published online: May 7, 2013
Processing time: 227 Days and 19.2 Hours
Abstract

AIM: To evaluate the use of medical adhesive spray in endoscopic submucosal dissection (ESD).

METHODS: Patients who underwent ESD between January 2009 and June 2012 (n = 173) were enrolled in the prospective randomized study. Two patients undergoing surgery due to severe intraoperative hemorrhage and failed hemostasis were excluded, and the remaining 171 patients were randomly divided into two groups: group A (medical adhesive group, n = 89) and group B (control group, n = 82). In group A, a medical adhesive spray was evenly applied after routine electrocoagulation and hemostasis using hemostatic clip after ESD. Patients in group B only treated with routine wound management. Intraoperative and postoperative data were collected and compared.

RESULTS: In all 171 patients, ESD was successfully completed. There was no significant difference in the average treatment time between groups A and B (59.4 min vs 55.0 min, respectively). The average length of hospital stay was significantly different between group A and B (8.89 d vs 9.90 d, respectively). The incidence of intraoperative perforation was 10.1% in group A and 9.8% in group B, and was not significantly different between the two groups. In all cases, perforations were successfully managed endoscopically and with conservative treatment. The incidence of postoperative delayed bleeding in group A was significantly lower than that in group B (0.00% vs 4.88%, respectively).

CONCLUSION: ESD is an effective minimally invasive treatment for gastrointestinal precancerous lesions or early-stage gastrointestinal cancer. Medical adhesive spray is effective in preventing delayed bleeding after ESD, and can thus reduce the average length of hospital stay.

Keywords: Endoscopic submucosal dissection; Medical adhesive; Early-stage gastrointestinal cancer; Postoperative delayed bleeding; Intraoperative hemorrhage

Core tip: This is the first report to use medical adhesive after endoscopic submucosal dissection (ESD), and results were exciting. Application of medical adhesive spray can prevent complications of ESD, especially the delayed bleeding, consequently reducing the average length of hospital stay, and avoiding additional health care expenditures.