Background Delayed bleeding (DB) after endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) remains a significant clinical problem. This study aimed to evaluate the safety and efficacy of a new gel hemostatic powder (GHP) for the prevention of DB in high-risk patients. Methods A prospective, multicentric, open-label study was conducted at seven Belgian hospitals from 2023 to 2024 in patients undergoing EMR or ESD for lesions over 20 mm with high risk of DB (either anticoagulant or P2Y12RA treated, or undergoing duodenal EMR). The Nexpowder GHP preventive spray was applied to the resected area at the end of the procedure. The primary outcome was the rate of DB within 4 weeks post-procedure. Secondary outcomes included safety, procedure duration, post-procedural pain, and incidence of adverse events. Results Fifty patients were enrolled in the study and treated with endoscopic resection followed by GHP application. The observed DB rate was 22% (11/50), higher than the literature-reported rate of 16%. The hypothesized reduction in DB below 5% was not achieved ( p = 0.2472). DB was most common in rectal ESD ( n = 3/5; 60%) and duodenal EMR ( n = 6/20; 30%). DB typically occurred within the first 10 days post-procedure (median onset 7d). On univariate analysis, the only factor associated with DB risk was lesion size ( p = 0.042). No adverse events related to the use of the GHP were reported. Conclusion In this prospective study, GHP demonstrated limited efficacy for the prevention of DB in high-risk patients, with a 22% observed DB rate. Lesion size and location were key predictors of DB.
Background and study aims Esophageal stricture is a common complication after extensive endoscopic submucosal dissection (ESD) for superficial esophageal cancer, requiring multiple interventions with substantial medical costs. Endoscopic conical cap dilatation is a novel, minimally invasive technique invented by Jinfeng Zhou, but its efficacy and safety compared to conventional endoscopic balloon dilatation remain unclear. Patients and methods We conducted a retrospective case-control study involving patients who developed esophageal strictures after ESD and underwent either endoscopic conical cap dilatation ( n = 32) or endoscopic balloon dilatation ( n = 64) between January 2020 and December 2024. The primary outcome was the stricture recurrence rate within 12 months. Secondary outcomes included technical success rate, number of dilatation sessions, procedure time, dysphagia improvement (Eckardt score), and complication rates. Results The endoscopic conical cap dilatation group had a significantly lower 12-month recurrence rate (22.6% vs. 56.7%, P = 0.002) and required fewer dilatation sessions (median 3 [2-4] vs. 5 [3-7], P < 0.001). Technical success rates were comparable (96.9% vs. 93.8%, P = 0.572). Procedure time was shorter in the endoscopic conical cap dilatation group (median 2 min [1-3] vs. 6 min [3-8], P < 0.001). Both groups showed significant Eckardt score improvement at 1 month ( P < 0.001), with no between-group difference ( P = 0.326). Complication rates were low (3.1% vs. 4.7%, P = 0.725), with no perforations in the endoscopic conical cap dilatation group. Conclusions This single-center retrospective cohort shows endoscopic conical cap dilatation yields promising preliminary results for post-ESD esophageal strictures, with lower recurrence, fewer sessions and shorter procedures and comparable safety versus balloon dilation. Further large randomized studies are required to confirm these findings.
