One patient underwent submucosal injection of epinephrine added sodium hyaluronate solution for lifting the mucosa. Administration of the

epinephrine was assessed as ineligible by the independent data and safety monitoring committee. When TDM-621 was applied to the lesion, gelation could be obtained easily as we planned (Fig. 1). The hemostatic effects were assessed in 12 patients. It was “remarkably effective” in Anti-infection Compound Library solubility dmso 11 patients and “effective” in 1 patient (Fig. 2). The time required for hemostasis was 105 ± 87 s. The amount of TDM-621 applied for hemostasis was 3.3 ± 2.1 ml. The operability was “very easy” in two patients, “easy” in eight patients, and “acceptable” in two patients. No secondary hemorrhage was observed in all of 12 patients. One of the patients administered sodium alginate after the ESD. Three

patients administered carbazochrome sodium sulfonate hydrate and tranexamic Tamoxifen mouse acid after the EMR or ESD. Eight patients were not administered any hemostatic agent. No adverse effect considered to be related to TDM-621 was observed. The abnormal findings in the blood examination, which cannot be denied the relationship to TDM-621, were the mild elevation of uremic acid or the mild elevation of transaminases. In the present study, it is shown that hemostasis using TDM-621 was feasible against oozing after endoscopic treatments of the gastric tumors. The hemostasis was obtained with easy operability and without any obvious adverse event. The post operative bleeding reported with more than 1000 ESD lesions were detected in 3.1,[5] 5.0,[6] 5.5,[7] 5.7,[8] 5.8,[9] 6.9,[10] and 15.5%[11] cases. It was reported that post-ESD bleeding controlled by urgent endoscopy was divided into four categories: spurting (two cases), oozing (four cases), exposed vessel (one case), and old blood clots (one case).[12] The post-ESD oozing is considered to

be an important issue. In the present study, the hemostatic effects of TDM-621 were good enough and no secondary selleck inhibitor hemorrhage (post-ESD bleeding) was observed. A few of clinically available hemostats can be applied under endoscopy. Thrombin is a conventional effective hemostat that can be used under endoscopy. Generally, the resource of thrombin is bovine blood, and administration of the thrombin cannot eliminate the potential risk of infections and allergic reactions. Sodium alginate is another effective hemostat that can be used under endoscopy [13]. However, this agent is powder and requires the equipment to spray on the bleeding points. Using the TDM-621, the hemostasis can be obtained without the equipment. In this point, the operability was assessed in the present study in order to check whether any trouble or mistake could be occurred when TDM-621 was applied to bleeding points. Moreover, few evidences showed the efficacy of drugs by dispersion such as thrombin and sodium alginate to active oozing after EMR and ESD.