A pilot study on the efficacy of cyanoacrylate glue in preventing post-ESD bleeding at the gastric angle.

BACKGROUND: Post-endoscopic submucosal dissection (ESD) bleeding at the gastric angle remains challenging due to the difficulty of closing mucosal defects. This pilot study aimed to evaluate whether prophylactic application of cyanoacrylate glue (CG) reduces bleeding risk in this high-risk location. METHODS: This multicenter, retrospective study included 385 patients who underwent ESD for gastric angle lesions at five institutions between January 2019 and December 2025. Patients were assigned to either the CG group (n = 136) or the conventional group (n = 249). To minimize selection bias, 1:1 propensity score matching (PSM) was performed. The primary outcome was the incidence of post-ESD bleeding, and multivariable logistic regression was performed to identify independent risk factors. Secondary outcomes included bleeding rates in predefined subgroups based on tumor size (≥ 4.0 cm vs. < 4.0 cm), antithrombotic use, and bleeding risk status (high-risk defined as tumor ≥ 4.0 cm or antithrombotic therapy). RESULTS: The incidence of post-ESD bleeding was significantly lower in the CG group than in the conventional group (4.4% vs. 14.1%; P = 0.003), with 95% CIs of 2.0-9.4% and 10.3-19.0%, respectively. After 1:1 PSM, results remained consistent (P < 0.001), with multivariable analysis identifying conventional management as an independent risk factor (OR = 4.54; 95% CIs: 1.76-11.73; P = 0.002). This protective effect was consistently observed across high-risk subgroups: tumors ≥ 4.0 cm (4.7% vs. 18.3%; P = 0.003), antithrombotic users (7.7% vs. 39.7%; P < 0.001), and high-risk patients (5.9% vs. 18.5%; P = 0.003). Accordingly, the median postoperative hospital stay was significantly shorter in the CG group overall (4.0 vs. 5.0 days; P < 0.001), as well as after PSM. CONCLUSIONS: Cyanoacrylate glue prophylaxis after gastric angle ESD may reduce bleeding and hospital stay, particularly in high-risk patients. However, retrospective design and small sample size warrant cautious interpretation and prospective confirmation.