University of Kansas
School of Medicine
Kansas City, Kansas
This edition of Sharma’s Endoscopy Insights examines the practice of adding a mucosal adhesive powder to standard therapy for controlling upper gastrointestinal bleeding, specifically ulcer bleeding, and evaluates the role of endoscopic submucosal dissection for removing lesions from previously attempted polypectomies that can lead to submucosal fibrosis.
Rebleeding after standard endoscopic intervention for upper GI bleeding can lead to high mortality and prolonged hospital stays. The first study I discuss evaluated the use of a hemostatic powder and demonstrated that its application following standard endoscopic hemostasis reduced rebleeding rates, particularly in patients with ulcer-related upper GI bleeding.
During colonoscopy, sometimes attempts to completely remove colorectal lesions are unsuccessful, in which case the patient is referred to a tertiary care center for further removal. The second study I discuss is an international multicenter study that showed that the use of salvage ESD was effective in the treatment of these incompletely removed colorectal lesions when performed by expert endoscopists.
Hemostatic Powder for GI Bleeding
Gut 2025 May 13. doi:10.1136/gutjnl-2024-332459
In this study, researchers in South Korea looked at the effectiveness of the hemostatic powder Nexpowder (NEXTBIOMEDICAL) in reducing rebleeding rates in patients with nonvariceal upper GI bleeding after conventional endoscopic treatment.
The prospective, multicenter, randomized, single-blind study, conducted across three institutions in South Korea from November 2018 to November 2021, included 341 total patients, 173 in the group that received the powder and 168 in the control group.
In the study group, one vial (3 g) of Nexpowder was applied to the lesion. A second vial was applied if the first dose did not fully cover the bleeding site. Patients were monitored for three days in the hospital after the procedure and for 30 days via phone or outpatient visits.
The 72-hour rebleeding rate—the study’s primary outcome—was significantly lower in the group that received the powder (2.9%; 95% CI, 0.9%-6.6%) compared with the control group (11.3%; 95% CI, 6.9%-17.1%) (P=0.005).
Patients in the powder group also had a significantly lower 30-day cumulative rebleeding rate (7.0% vs. 18.8%; P=0.002). There were no reported adverse events related to the powder; all eight serious adverse events were attributed to the patients’ underlying medical conditions.
The investigators concluded that Nexpowder used as an adjunct with conventional endoscopic therapy can result in significantly lower rebleeding rates, but they cautioned that more comparative studies are needed, particularly those that compare different hemostatic agents.
Salvage ESD for Colorectal Lesions
Clin Gastroenterol Hepatol 2025 May 9. doi:10.1016/j.cgh.2025.02.021
In this study, an international group of researchers evaluated the safety and effectiveness of salvage ESD to treat previously attempted colorectal lesions.
The retrospective study was conducted across 21 centers (16 in North America, three in Europe and two in South America) between May 2014 and October 2022. Effectiveness was assessed by looking at rates of en bloc resection and R0 resection and local recurrence. Safety was assessed by looking at adverse events, procedure-related mortality and the need for further surgical management.
Out of 415 total lesions, the rates of en bloc, R0 and curative resection were 83.4%, 76.2% and 73.5%, respectively. Adverse events occurred in 48 patients (11.6%), the most common being intraprocedural perforation in 19 patients (4.6%). Two patients needed surgical management, and 17 were managed endoscopically.
The researchers concluded salvage ESD is a feasible and safe way to treat previously attempted colorectal lesions, but the study has limitations, including its retrospective design and a lack of long-term follow-up data.
Dr. Sharma is a member of the Gastroenterology & Endoscopy News editorial board.
This article is from the August 2025 print issue.