The Effect of Nexpowder in Reducing Post‐ESD Coagulation Syndrome in Proximal Colon Lesions: A Retrospective Multicenter Study

BACKGROUND: Endoscopic submucosal dissection (ESD) is an established curative treatment for lateral spreading tumors and early colorectal cancer, but it can cause procedure-related complications such as post-ESD coagulation syndrome (PECS), which may increase healthcare utilization, prolong hospitalization, and raise medical costs. Nexpowder (Nextbiomedical Co. Ltd., Incheon, Republic of Korea), a highly adhesive hemostatic powder approved by the U.S. FDA for nonvariceal upper gastrointestinal bleeding, has demonstrated efficacy in preventing rebleeding. This study aimed to evaluate the prophylactic efficacy of Nexpowder in preventing PECS after colorectal ESD for high-risk proximal lesions. METHODS: This retrospective multicenter study included patients who underwent colorectal ESD between April 2023 and October 2024 for PECS high-risk lesions, excluding those with perforation, muscular injury, or prophylactic clipping. Nexpowder was applied prophylactically in 35 patients (46.7%), while 40 patients (53.3%) served as controls. PECS was defined as postprocedural abdominal pain, fever, and elevated inflammatory markers requiring antibiotics. RESULTS: PECS occurred in nine patients overall. The incidence was significantly lower in the Nexpowder group (2.9% [CI 0.3-12.6]) than in the control group (20.0% [CI 9.9-34.2]; p = 0.032). All cases resolved with conservative treatment, and no surgical intervention was required. CONCLUSION: The application of Nexpowder was associated with a significant reduction in the incidence of PECS after high-risk colorectal ESD. This study provides the first clinical evidence that a topical barrier agent may serve as a simple and effective preventive strategy for PECS.