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. 2024 Sep 16;5(1):e70008.
doi: 10.1002/deo2.70008. eCollection 2025 Apr.

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

Jun Kanazawa  1 , Hisatomo Ikehara  1 , Toshiki Horii  1 , Gen Kitahara  1 , Tomohiro Betto  1 , Kaoru Yokoyama  1 , Kiyonori Kobayashi  1 , Chika Kusano  1
Affiliations

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

Jun Kanazawa et al. DEN Open. .

Abstract

Objective: 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.

Methods: 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.

Results: 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.

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

Keywords: ESD; PECS; VIO3; colon cancer; hemostasis.

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Conflict of interest statement

Hisatomo Ikehara has received lecture fees from Mundiphama Co., AI Medical Service Inc., Olympus Co., and FUJIFILM Co. Chika Kusano has received lecture fees from Takeda Pharmaceutical Co., EA Pharma Co., 3‐D Matrix Ltd., Boston Scientific Co., Olympus Marketing Inc., FUJIFILM Medical Co., and FUJIFILM Co.

Figures

FIGURE 1
FIGURE 1
The selection of the participants. ESD, endoscopic submucosal dissection.
See this image and copyright information in PMC

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