A novel self-assembling peptide hemostatic gel as an option for initial hemostasis in endoscopic sphincterotomy-related hemorrhage: a case series

Endoscopic sphincterotomy (EST) is a fundamental procedure of therapeutic endoscopic retrograde cholangiopancreatography, with post-EST bleeding as a serious adverse event. Although there are various hemostatic methods for post-EST bleeding, there is no consensus regarding the treatment choice. Pura...

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Bibliographic Details
Published in:Clinical journal of gastroenterology 2022-12, Vol.15 (6), p.1210-1215
Main Authors: Ishida, Yusuke, Tsuchiya, Naoaki, Koga, Takehiko, Kitaguchi, Takanori, Matsumoto, Keisuke, Kuno, Nobuaki, Funakoshi, Sadahiro, Ishibashi, Hideki, Ashizuka, Shinya, Hirai, Fumihito
Format: Article
Language:English
Subjects:
Abdominal Surgery
Case Report
Colorectal Surgery
Gastroenterology
Hepatology
Medicine
Medicine & Public Health
Surgical Oncology
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Summary:Endoscopic sphincterotomy (EST) is a fundamental procedure of therapeutic endoscopic retrograde cholangiopancreatography, with post-EST bleeding as a serious adverse event. Although there are various hemostatic methods for post-EST bleeding, there is no consensus regarding the treatment choice. PuraStat is a novel self-assembling peptide developed as a hemostatic agent. We report six cases of EST-related hemorrhage with initial hemostasis achieved using PuraStat. The cases were observed in four men and two women, with an average age of 77.8 years. EST was performed for biliary drainage in four cases and for stone removal in two cases. Bleeding occurred during the same session as EST in five of six cases, with the remaining case showing bleeding 4 days after EST. As all patients with EST-related hemorrhage presented oozing with stable vital signs, we selected PuraStat as first-line hemostasis in each case. We applied PuraStat using a dedicated catheter with the tip pressed against the bleeding point. Hemostasis was confirmed without additional procedure in all cases. No adverse events were noted after the procedures. As PuraStat hemostasis is effective, feasible, and safe for EST-related hemorrhage, PuraStat may be an option for initial hemostasis, although it is limited to oozing.
ISSN:1865-7257
1865-7265
DOI:10.1007/s12328-022-01702-9