title: Effects of medical adhesives in prevention of complications after endoscopic submucosal dissection.
abstract: OBJECTIVE
  To evaluate the use of medical adhesive spray in endoscopic submucosal dissection (ESD).
  
  
  METHODS
  Patients who underwent ESD between January 2009 and June 2012 (n = 173) were enrolled in the prospective randomized study. Two patients undergoing surgery due to severe intraoperative hemorrhage and failed hemostasis were excluded, and the remaining 171 patients were randomly divided into two groups: group A (medical adhesive group, n = 89) and group B (control group, n = 82). In group A, a medical adhesive spray was evenly applied after routine electrocoagulation and hemostasis using hemostatic clip after ESD. Patients in group B only treated with routine wound management. Intraoperative and postoperative data were collected and compared.
  
  
  RESULTS
  In all 171 patients, ESD was successfully completed. There was no significant difference in the average treatment time between groups A and B (59.4 min vs 55.0 min, respectively). The average length of hospital stay was significantly different between group A and B (8.89 d vs 9.90 d, respectively). The incidence of intraoperative perforation was 10.1% in group A and 9.8% in group B, and was not significantly different between the two groups. In all cases, perforations were successfully managed endoscopically and with conservative treatment. The incidence of postoperative delayed bleeding in group A was significantly lower than that in group B (0.00% vs 4.88%, respectively).
  
  
  CONCLUSIONS
  ESD is an effective minimally invasive treatment for gastrointestinal precancerous lesions or early-stage gastrointestinal cancer. Medical adhesive spray is effective in preventing delayed bleeding after ESD, and can thus reduce the average length of hospital stay.
authors.affiliation: Department of Digestive Endoscopy, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
authors.forename: Chun-Ying
authors.initials: CY
authors.lastname: Qu
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.forename: Qian-Wen
authors.initials: QW
authors.lastname: Ni
authors.forename: Lei-Ming
authors.initials: LM
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002681:China; D004210:Dissection / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors; D014014:Tissue Adhesives / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000336:Aerosols; D014014:Tissue Adhesives
keywords: Early-stage gastrointestinal cancer; Endoscopic submucosal dissection; Intraoperative hemorrhage; Medical adhesive; Postoperative delayed bleeding