Adjunctive fibrin glue for the prevention of bleeding after endoscopic submucosal dissection of gastroesophageal lesions: a systematic review and meta-analysis.

BACKGROUND AND AIM: Bleeding after endoscopic submucosal dissection (ESD) is a relevant complication that may require urgent endoscopic intervention. Emerging evidence suggests that fibrin glue use after conventional hemostasis may reduce bleeding. This meta-analysis aimed to evaluate the association between fibrin glue use and the prevention of post-ESD ulcer bleeding in gastroesophageal lesions. METHODS: PubMed, embase, and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) and observational studies evaluating the use of fibrin glue as an adjunctive treatment after ESD for bleeding prevention. Outcomes were analyzed using risk ratios (RR) with 95% confidence intervals (CI), and heterogeneity was assessed using I2. RESULTS: Seven studies were included (2 RCTs and 5 observational studies), totaling 2141 patients who underwent ESD. Fibrin glue did not decrease the incidence of post-ESD overall bleeding in gastroesophageal lesions (RR: 0.67; 95% CI 0.29-1.57; p = 0.354; I2 = 73.5%). Stratifying by anatomical site, no differences were observed in the reduction of overall bleeding in the esophagus (RR: 2.14; 95% CI 0.32-14.17; p = 0.430; I2 = 0%) or stomach (RR: 0.75; 95% CI 0.36-1.59; p = 0.460; I2 = 72.2%). No differences were observed in early bleeding reduction (RR: 0.33; 95% CI 0.08-1.39; p = 0.130; I2 = 59.2%) or delayed bleeding (RR: 1.10; 95% CI 0.56-2.17; p = 0.776; I2 = 6.6%). CONCLUSION: Fibrin glue was not associated with a reduction in bleeding after ESD of gastroesophageal lesions. However, future studies should further evaluate its impact on high-risk subpopulations.