Aims
Endoscopic submucosal dissection (ESD) is an established curative treatment for lateral spreading tumors and early colorectal cancer, but it can cause procedure-related complications such as post-ESD coagulation syndrome (PECS). Proximal tumor location is a known independent risk factor for PECS. Nexpowder™ (NEXTBIOMEDICAL CO., LTD.Nextbiomedical, Incheon, Republic of Korea), a highly adhesive hemostatic powder approved by the US FDA for non-variceal upper gastrointestinal bleeding, has demonstrated efficacy in preventing rebleeding. This study aimed to evaluate the prophylactic efficacy of Nexpowder in preventing PECS after colorectal ESD for high-risk proximal lesions.
Methods
This retrospective multicenter study included patients who underwent colorectal ESD between April 2023 to October 2024 for proximal colonic lesions, without perforation, muscular injury, or prophylactic clipping. Nexpowder was applied prophylactically in 35 patients (46.7%), while 40 patients (53.3%) served as controls. PECS was defined as postprocedural abdominal pain, fever, and elevated inflammatory markers requiring antibiotics.
Results
PECS occurred in nine patients overall. The incidence of PECS was significantly lower in the Nexpowder group (2.9%) than in the control group (20.0%; p = 0.032). All cases improved with conservative treatment, and no surgical intervention was required.
Study outcomes
|
Variables |
Control group (n = 40) |
Nexpowder group (n = 35) |
P-value |
|
PECS, n (%) |
8 (20.0) |
1 (2.9) |
0.032+ |
|
Abdominal pain (≥ NRS 4) |
9 (22.5) |
2 (5.7) |
0.053+ |
|
Fever (≥38.0℃) |
9 (22.5) |
1 (2.9) |
0.016+ |
|
White blood cell count increase, /ul |
9 (22.5) |
6 (17.1) |
0.561 |
|
C-reactive protein increase more than 1mg/dL |
11 (27.5) |
6 (17.1) |
0.406 |
|
Powder associated adverse event, n (%) |
|
|
|
|
Colonic obstruction |
|
0 (0.0) |
- |
|
Perforation |
|
0 (0.0) |
- |
|
Infection |
|
0 (0.0) |
- |
|
Embolization |
|
0 (0.0) |
- |
§Median (range)
+Fisher exact test
*P-values were calculated using the t-test or Fisher calculated using of the control group and the Nexpowder group
Conclusions
Prophylactic application of Nexpowder significantly reduced the incidence of PECS after high-risk colorectal ESD. This study provides the first clinical evidence that a topical barrier agent may serve as a simple and effective preventive strategy for PECS.