The study evaluates the association of SAP use with delayed bleeding and endoscopic healing after advanced endoscopic therapy. The findings may support the integration of SAP into standard post-endoscopic care protocols.

A retrospective analysis was conducted at a single tertiary endoscopy center including consecutive patients undergoing EMR or ESD. The primary outcome was delayed bleeding within 30 days, defined as clinically evident bleeding requiring medical attention. Secondary outcomes included endoscopic healing of the post-resection defect at 4, 8, and 24 weeks using the Sakita–Fukutomi classification. Defect size was measured during the index procedure using endoscopic forceps or a polypectomy snare as reference. Data were abstracted from medical records.

A total of 167 patients were included (65 women, 102 men). Procedures comprised ESD in 110 (66 %), piece-meal EMR in 47 (28 %), hybrid EMR+ESD in 8 (5 %), and en bloc EMR in 2 (1 %). Lesion locations were esophagus 19 (11 %), stomach 18 (11 %), duodenum 3 (2 %), colon 34 (20 %), and rectum 93 (56 %). Mean lesion size was 35.5 (SD 21.5) mm. Among 112 en bloc resections, R0 was achieved in 84 (75 %). Delayed bleeding occurred in 6 patients (4 %), with a median onset of 4 days (range 0–13). All cases were managed endoscopically: SAP alone (n=3), SAP plus coagulation (n=1), coagulation plus hemoclips (n=1), and coagulation plus hemostatic powder (n=1); 2 patients required transfusion. Mean post-resection defect size was 38.4 (SD 20.2) mm, decreasing to 20.4 mm, 13.7 mm, and 10.9 mm at 4, 8, and 24 weeks, corresponding to 47%, 64%, and 72% reductions, respectively.

In this single-center cohort, use of a self-assembling peptide was associated with a low rate of delayed bleeding and progressive endoscopic healing of post-resection defects after EMR/ESD. These findings support the selective use of SAP to enhance the safety of advanced endoscopic procedures; prospective controlled studies are warranted.

The project is supported by the Ministry of Health of the Czech Republic (NU22-08-00424) and Scientific projects MO1012 and Cooperatio.