Novel Hemostatic Gel As Rescue Therapy for Postsphincterotomy Bleeding Refractory to Self-Expanding Metallic Stent Placement

Abstract

Endoscopic sphincterotomy (ES) is commonly performed during endoscopic retrograde cholangiopancreatography, and bleeding is a severe adverse event. PuraStat is a peptide developed as a hemostatic agent for endoscopy. We report its use as a hemostatic strategy in post-ES bleeding refractory to combined hemostasis. A patient with choledocholithiasis underwent endoscopic retrograde cholangiopancreatography for stone removal. After the ES, severe bleeding refractory to the injection of diluted epinephrine around the bleeding source and metal stent placement occurred. Hemostasis was achieved with the application of the hemostatic gel. We reported the use of novel self-assembling hemostatic gel as an effective therapeutic tool for post-ES refractory bleeding.

Efficacy of Combination Therapy with Epinephrine Local Injection and Hemostatic Clips on Active Diverticular Bleeding

“…Recent therapeutic advances have given rise to an abundance of hemostatic techniques that endoscopists have at their disposal for the treatment of diverticular bleeding, such as CT-guided percutaneous injections of epinephrine and cyanoacrylate, with various new techniques typically seen in the upper gastrointestinal tract, which may become applicable to diverticular bleeds in the future [ 25 , 26 , 27 ]. Epinephrine local injection is a simple and basic therapy first reported in the late 1980s for diverticular bleeding with high rates of hemostasis [ 17 , 18 ].…”

Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics

“…Especially in patients with >1 risk factor for intra‐procedural endoscopic retrograde cholangiopancreatography (ERCP) bleeding, RADA16 peptide hydrogel‐based endoscopic application was an excellent third‐line hemostatic strategy with high safety profile for post‐EST bleeding ( Figure A). [ 243 ] For the hemostatic treatment of acute intrahepatic biliary duct bleeding, because the bleeding site was inaccessible using other endoscopic hemostatic devices, an alternative option is the off‐label application of injectable hydrogel. In a series of case reports in EST‐related hemorrhages, [ 244 ] PuraStat RADA16 peptide solution achieved effective and safe first‐line hemostasis in oozing bleeding scenarios.…”

“…Reproduced with permission. [ 243 ] Copyright 2022, PMC. B) Topical hemostatic application of SPG‐178 medical device on the left hepatic lobe with ventral, inferior, horizontal incisions.…”

Rapid hemostasis using a self-assembling peptide matrix for midprocedural bleeding in endoscopic sphincterotomy

“…Although various hemostatic techniques, such as balloon compression, clipping, cautery, and covered metallic stents, are usually carried out, they are time-consuming, costly, risky, and difficult to perform 1 . Recently, the efficacy of a novel self-assembling peptide matrix (PuraStat; 3-D Matrix Europe SAS, France) has been reported for hemostasis in gastrointestinal endoscopic procedures 2 3 4 5 . We describe two cases in which PuraStat was effective for rapid hemostasis of post-sphincterotomy bleeding during ERCP ( Video 1 ).…”