title: Effectiveness of Surgicel® (Fibrillar) in patients with colorectal endoscopic submucosal dissection.
abstract: OBJECTIVE
  Because the invasive procedure of colorectal endoscopic submucosal dissection (ESD) entails a extensive mucosal defect and submucosal exposure, the procedure may have a substantial risk of complications including delayed bleeding, perforation and bacteremia and/or endotoxemia. The aim of our study was to investigate whether Surgicel(®) would be effective in reducing complications after colorectal ESD.
  
  
  METHODS
  Between 2012 and 2013, 52 consecutive patients who underwent a colorectal ESD were enrolled. After the removal of colorectal epithelial neoplasm, surgicel was sprayed onto the submucosal surface using the wet type of application (Surgicel(®) group). We evaluated tumor type, location, size, histology, procedure time, hospital stay and associated complication. For assessing inflammatory reaction, white blood cells and body temperature were monitored. In assessing the effectiveness of Surgicel(®) application, we retrospectively compared the clinical outcomes with 52 other consecutive large colorectal tumor patients who had previously received conventional ESD, as control group (non-Surgicel(®) group).
  
  
  RESULTS
  Of the 52 patients, three patients were excluded. Forty-nine patients were ultimately enrolled in this study. During the follow-up period, rebleeding occurred in 0 (0% in Surgicel(®) group) patients and 4 (7.7% in non-Surgicel(®) group) patients; fever (>37.7) in 2 (4.1%) and 10 (19.2%) patients, respectively (p = 0.019); and leukocytosis in 9 (18.4%) and 16 (30.8%) patients, respectively (p = 0.172). C-reactive protein level was 0.35 ± 0.18 and 9.83 ± 2.44 (p < 0.001). The mean hospitalization period was 4.22 ± 0.94 and 5.13 ± 0.27 days, respectively (p < 0.001). The group (surgicel vs. non-surgicel, p = 0.005, odds ratio 11.114 (2.104-58.718)) was identified as independent predictor for complication such as fever or delayed bleeding by multivariated analysis.
  
  
  CONCLUSIONS
  Surgicel(®) application after colorectal ESD may be an effective method to reduce some complications and mean hospitalization period. Therefore, surgicel application may be considered to be a valuable clinical method.
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon and seoul Hospital, Soonchunhyang University College of Medicine, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Korea.
authors.forename: Yu Sik
authors.initials: YS
authors.lastname: Myung
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon and seoul Hospital, Soonchunhyang University College of Medicine, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Korea. kopa9445@schmc.ac.kr.
authors.forename: Bong Min
authors.initials: BM
authors.lastname: Ko
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon and seoul Hospital, Soonchunhyang University College of Medicine, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Korea.
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon and seoul Hospital, Soonchunhyang University College of Medicine, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon and seoul Hospital, Soonchunhyang University College of Medicine, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Korea.
authors.forename: Seong Ran
authors.initials: SR
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon and seoul Hospital, Soonchunhyang University College of Medicine, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Korea.
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon and seoul Hospital, Soonchunhyang University College of Medicine, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon and seoul Hospital, Soonchunhyang University College of Medicine, 1174 Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-do, 420-767, Korea.
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
mesh_terms: D016022:Case-Control Studies; D002483:Cellulose, Oxidized; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D004210:Dissection; D016145:Endoscopy, Digestive System; D005260:Female; D006490:Hemostatics; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies
chemical_list: D002483:Cellulose, Oxidized; D006490:Hemostatics; C013695:Surgicel
keywords: Colorectal ESD; Complication; Surgicel