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Background <p>Delayed bleeding following endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) remains a recognized adverse event. Despite observational studies suggesting lower delayed bleeding rates with the use of self-assembling peptide (SAP), randomized data have yielded inconsistent results, precluding routine prophylactic application. We aimed to evaluate the effectiveness of SAP in preventing delayed bleeding after ESD and EMR.</p> Methods <p>We systematically searched PubMed, Embase, and the Cochrane Library through October 2025 for prospective or retrospective cohorts reporting delayed bleeding following ESD or EMR in direct association with adjunctive SAP application, with or without a comparator group. Random-effects meta-analyses estimated pooled delayed bleeding rates and, where applicable, risk ratios (RR), with prespecified subgroup analyses by resection technique.</p> Results <p>Eleven studies comprising 928 patients were included. Comparative analyses (five studies), SAP in conjunction with standard therapy was not associated with a reduction in delayed bleeding compared with standard care (RR 1.34, 95% CI 0.83–2.18; I<sup>2</sup> = 0%). Findings were consistent in a sensitivity analysis restricted to randomized controlled trials (RR 1.53, 95% CI 0.85–2.76; I<sup>2</sup> = 0%) and in a subgroup analysis of ESD-only studies (RR 1.16, 95% CI 0.65–2.08; I<sup>2</sup> = 0%). In single-arm analyses, the pooled delayed bleeding rate following SAP application was 6.7% (95% CI 3.9–10.2%; I<sup>2</sup> = 71.5%). Among anticoagulated patients (five studies; n = 108), the pooled bleeding rate was 11.5% (95% CI 6.3–18.0%; I<sup>2</sup> = 0%). Procedure-specific analyses demonstrated similar bleeding rates after ESD and EMR, with substantial heterogeneity observed in EMR cohorts.</p> Conclusion <p>Prophylactic SAP after ESD or EMR yielded delayed bleeding rates comparable to baseline, indicating no added benefit over standard practice. In anticoagulated patients, outcomes similarly matched historical benchmarks, with no evident protective effect. Further studies are required to define the patients most likely to benefit from SAP.</p> Graphical abstract <p></p>

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Role of topical self-assembling peptide in preventing delayed bleeding following advanced endoscopic resection: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年5月19日

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  • Dimo Dimitrov,
  • Harishankar Gopakumar,
  • Daryl Ramai,
  • Kobina Essilfie-Quaye,
  • Lynn Warner,
  • Sulaiman Almushir,
  • Jason Dubroff,
  • Faisal Aljohani,
  • Abdulrahman Qatomah,
  • Hiroyuki Aihara

摘要

Background

Delayed bleeding following endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) remains a recognized adverse event. Despite observational studies suggesting lower delayed bleeding rates with the use of self-assembling peptide (SAP), randomized data have yielded inconsistent results, precluding routine prophylactic application. We aimed to evaluate the effectiveness of SAP in preventing delayed bleeding after ESD and EMR.

Methods

We systematically searched PubMed, Embase, and the Cochrane Library through October 2025 for prospective or retrospective cohorts reporting delayed bleeding following ESD or EMR in direct association with adjunctive SAP application, with or without a comparator group. Random-effects meta-analyses estimated pooled delayed bleeding rates and, where applicable, risk ratios (RR), with prespecified subgroup analyses by resection technique.

Results

Eleven studies comprising 928 patients were included. Comparative analyses (five studies), SAP in conjunction with standard therapy was not associated with a reduction in delayed bleeding compared with standard care (RR 1.34, 95% CI 0.83–2.18; I2 = 0%). Findings were consistent in a sensitivity analysis restricted to randomized controlled trials (RR 1.53, 95% CI 0.85–2.76; I2 = 0%) and in a subgroup analysis of ESD-only studies (RR 1.16, 95% CI 0.65–2.08; I2 = 0%). In single-arm analyses, the pooled delayed bleeding rate following SAP application was 6.7% (95% CI 3.9–10.2%; I2 = 71.5%). Among anticoagulated patients (five studies; n = 108), the pooled bleeding rate was 11.5% (95% CI 6.3–18.0%; I2 = 0%). Procedure-specific analyses demonstrated similar bleeding rates after ESD and EMR, with substantial heterogeneity observed in EMR cohorts.

Conclusion

Prophylactic SAP after ESD or EMR yielded delayed bleeding rates comparable to baseline, indicating no added benefit over standard practice. In anticoagulated patients, outcomes similarly matched historical benchmarks, with no evident protective effect. Further studies are required to define the patients most likely to benefit from SAP.

Graphical abstract