P2028 - A Systematic Review and Meta-Analysis on the Efficacy of Fibrin Sealant in Preventing Post-Endoscopic Submucosal Dissection Bleeding

Kyaw Min Tun, DO¹, Syed Mohsin Saghir, MD², Lubaba Haque, DO¹, Jay Bapaye, MBBS, MD³, Humzah Iqbal, MD⁴, Banreet S. Dhindsa, MD⁵, Saurabh Chandan, MD, MBBS⁶, Rajani Rangray, MBBS⁷, Douglas G. Adler, MD^8
1Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV; ²Creighton University, Omaha, NE; ³Rochester General Hospital, Rochester, NY; ⁴University of California San Francisco, Fresno, Fresno, CA; ⁵University of Nebraska Medical Center, Omaha, NE; ⁶Creighton University School of Medicine, Omaha, NE; ⁷CHI Health Creighton University Medical Center, Omaha, NE; ⁸Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: Endoscopic submucosal dissection (ESD) is a therapeutic technique for removing gastrointestinal neoplasms. However, due to the mucosal defect created during the procedure, delayed bleeding after ESD is a common complication. The use of fibrin sealant with polyglycolic acid (PGA) sheets is effective in achieving hemostasis and in preventing delayed bleeding. However, application of the PGA sheets through an endoscope is technically challenging and may require longer procedure time than ESD itself. We performed a systematic review and meta-analysis to determine whether fibrin alone can prevent delayed bleeding in patients who undergo ESD.

Methods: We performed a comprehensive literature search from major databases from inception to May 2023. The primary outcome was the risk of delayed bleeding in patients who received fibrin compared to those who did not receive fibrin or other hemostatic agents after ESD. Delayed bleeding was defined as hematemesis, melena, decline in hemoglobin level by ≥2 g/dL from the preoperative level, or other symptoms that required endoscopic hemostasis between 24 hours to 4 weeks after ESD. A pooled estimate of the risk ratio was calculated using random-effects model with a 95% confidence interval (CI) and a CMA v 3.0 software (BioStat, Englewood, NJ).

Results: Our analysis included 4 studies comprised of 1 randomized controlled trial and 3 retrospective cohort studies. There were 1184 patients with 455 patients in the fibrin cohort and 729 patients in the non-fibrin cohort. Approximately 62% and 38% of patients were males and females, respectively. The mean age was 62 years. Antithrombotic therapy was discontinued in all patients except in 11 patients from the fibrin group and in 7 patients from the non-fibrin group. There was no issue with administration of fibrin. The calculated rate of bleeding was 3.30% (n=15) in the fibrin group and 4.25% (n=31) in the non-fibrin group. The pooled risk ratio for bleeding with fibrin vs without fibrin was -0.64 (95% CI: 0.17, 2.45; p=0.17; I²=40%) (Figure 1). Moderate heterogeneity was observed.

Discussion: The pooled risk ratio suggests a lower risk of bleeding in the fibrin group vs the non-fibrin group. However, the result was not statistically significant. Further randomized controlled trials and comparative analyses are required to validate the role of fibrin alone without PGA sheets in hemostasis post-ESD.



Disclosures:


Kyaw Min Tun, DO¹, Syed Mohsin Saghir, MD², Lubaba Haque, DO¹, Jay Bapaye, MBBS, MD³, Humzah Iqbal, MD⁴, Banreet S. Dhindsa, MD⁵, Saurabh Chandan, MD, MBBS⁶, Rajani Rangray, MBBS⁷, Douglas G. Adler, MD⁸. P2028 - A Systematic Review and Meta-Analysis on the Efficacy of Fibrin Sealant in Preventing Post-Endoscopic Submucosal Dissection Bleeding, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.