Effect of spray COAG mode on hemostasis in colorectal endoscopic submucosal dissection using inverse probability of treatment weight analysis

TL;DR

This study shows that using Spray COAG during colorectal ESD reduces the need for hemostatic forceps and lowers a specific postoperative complication.

Contribution

Demonstrates the effectiveness of Spray COAG for intraoperative hemostasis in colorectal ESD using a novel statistical method.

Findings

Spray COAG significantly reduced the use of hemostatic forceps during ESD.

The prevalence of post-ESD electrocoagulation syndrome decreased significantly with Spray COAG.

No significant differences were found in perforation or postoperative bleeding rates.

Abstract

Swift and forced COAG with an electrosurgical knife are commonly used for intraoperative hemostasis in colorectal endoscopic submucosal dissection (ESD). If bleeding cannot be stopped using an electrosurgical knife, cauterization is attempted using hemostatic forceps. Since April 2022, our hospital has started using Spray COAG for intraoperative hemostasis for colorectal ESD. This study aimed to provide evidence of the efficacy of Spray COAG for intraoperative hemostasis.

Colorectal ESD was performed for 320 lesions at our hospital. Of these, 307 were included; 145 and 162 lesions were operated before and after the introduction of Spray COAG, respectively. Spray COAG was used after the change. The primary endpoint was the change in the frequency of use of hemostatic forceps after the introduction of Spray COAG; the secondary endpoint was the change in the prevalence of postoperative complications after the introduction of Spray COAG. It should be noted that the Spray COAG mode was employed solely for hemostasis and not for dissection, while the Swift COAG mode was utilized for dissection in the After Spray COAG group. Statistical analysis was conducted using IPTW analysis.

The frequency of use of hemostatic forceps was significantly decreased after the introduction of Spray COAG (odds ratio = 0.12, 95% confidence interval [95%CI]: 0.06–0.23, p < 0.001). The prevalence of post‐ESD electrocoagulation syndrome significantly decreased (odds ratio = 0.43, 95%CI: 0.22–0.88, p = 0.02). No significant differences were observed between the intraoperative and postoperative perforations or rate of postoperative bleeding.

Spray COAG reduced the frequency of hemostatic forceps use in colorectal ESD.

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