A novel polysaccharide hemostatic agent in prevention of post-procedural bleeding following large colonic polyp resection

Background and study aims Preventing post-procedural bleeding (PPB) after endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) is crucial for minimizing post-endoscopic complications. We aimed to evaluate the rate of PPB in large colorectal lesions removed via EMR or ESD, followed by application of a resorbable plant-based hemostatic powder (HaemoCer PLUS). Patients and methods This prospective pilot study was conducted at three tertiary care centers from November 2021 to February 2024. HaemoCer PLUS was applied at the end of the procedure and spread over the post-resection surface. No endoscopic clips were used after resection. Results The study included 50 patients with a mean lesion diameter of 52.28 mm (standard deviation 18.29 mm). Fifty-six percent of the polyps were in the rectum and 86% were classified as adenomas. ESD was used to remove 20 lesions, hybrid ESD for eight, Hot-EMR for 17, and cold-EMR for five. All patients received HaemoCer PLUS application for PPB prevention. Delayed bleeding was observed in 6% of cases, including one case of ESD and two cases of hot-snare resection. PPB occurred 24 hours after the procedure and no bleeding cases were reported more than 30 days post-endoscopy. Univariate analysis showed no statistically significant associations between post-procedural bleeding and lesion size, patient age, or endoscopic resection technique. Conclusions Use of a novel resorbable plant-based hemostatic powder could be a beneficial method for reducing delayed bleeding complications, particularly in high-risk groups characterized by specific lesions and patient factors.