Haemostasis and Prevention of Bleeding Related to ER: The Role of a Novel Self-assembling Peptide

Overview

Journal United European Gastroenterol J

Publisher Wiley

Specialty Gastroenterology

Date 2019 Feb 22

PMID 30788128

Citations 35

Authors

Sharmila Subramaniam

Kesavan Kandiah

Sreedhari Thayalasekaran

Gaius Longcroft-Wheaton

Pradeep Bhandari

Affiliations

Soon will be listed here.

Abstract

Background: Endoscopic resection is now commonly used for removal of early gastrointestinal lesions. However, the risk of the procedure may be heightened by intraprocedural or delayed bleeding. A novel, self-assembling peptide (PuraStat®) was recently licensed for use as a haemostat.

Objective: The aim of this study was to assess the efficacy and safety of this haemostat when used to control intraprocedural bleeding or to prevent delayed bleeding in endoscopic resection.

Methods: PuraStat® was used on 100 patients undergoing endoscopic resection in a tertiary referral centre. The efficacy, safety, feasibility of use and delayed bleeding rates were measured.

Results: Forty-eight oesophageal, 31 colorectal, 11 gastric and 10 duodenal procedures were included. The mean lesion size was 3.7 cm and 30% of the patients were on antithrombotic therapy. Intraprocedural bleeding occurred in 64%. PuraStat® was an effective haemostat in 75% of these cases. Only a small amount was required for haemostasis (mean = 1.76 ml) and it took on average 69.5 seconds to stop a bleed. The delayed bleeding rate was 3%.

Conclusions: PuraStat® is an effective haemostat for use in controlling bleeds during endoscopic resection. It is safe, easy to use and did not interfere with the procedure.

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References

Fuccio L, Hassan C, Ponchon T, Mandolesi D, Farioli A, Cucchetti A . Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2017; 86(1):74-86.e17. DOI: 10.1016/j.gie.2017.02.024. View

Pioche M, Camus M, Rivory J, Leblanc S, Lienhart I, Barret M . A self-assembling matrix-forming gel can be easily and safely applied to prevent delayed bleeding after endoscopic resections. Endosc Int Open. 2016; 4(4):E415-9. PMC: 4831935. DOI: 10.1055/s-0042-102879. View

Burgess N, Metz A, Williams S, Singh R, Tam W, Hourigan L . Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol. 2013; 12(4):651-61.e1-3. DOI: 10.1016/j.cgh.2013.09.049. View

Uraoka T, Ochiai Y, Fujimoto A, Goto O, Kawahara Y, Kobayashi N . A novel fully synthetic and self-assembled peptide solution for endoscopic submucosal dissection-induced ulcer in the stomach. Gastrointest Endosc. 2015; 83(6):1259-64. DOI: 10.1016/j.gie.2015.11.015. View

Park Y, Cho E, Kang H, Kim J . The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc. 2011; 25(8):2666-77. DOI: 10.1007/s00464-011-1627-z. View

Burgess N, Williams S, Hourigan L, Brown G, Zanati S, Singh R . A management algorithm based on delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol. 2014; 12(9):1525-33. DOI: 10.1016/j.cgh.2014.01.026. View

Desai M, Saligram S, Gupta N, Vennalaganti P, Bansal A, Choudhary A . Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett's esophagus-related neoplasia: a systematic review and pooled analysis. Gastrointest Endosc. 2016; 85(3):482-495.e4. DOI: 10.1016/j.gie.2016.09.022. View

Lian J, Chen S, Zhang Y, Qiu F . A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc. 2012; 76(4):763-70. DOI: 10.1016/j.gie.2012.06.014. View

Kataoka Y, Tsuji Y, Sakaguchi Y, Minatsuki C, Asada-Hirayama I, Niimi K . Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods. World J Gastroenterol. 2016; 22(26):5927-35. PMC: 4948274. DOI: 10.3748/wjg.v22.i26.5927. View

10.

Huang R, Pan Y, Hui N, Guo X, Zhang L, Wang X . Polysaccharide hemostatic system for hemostasis management in colorectal endoscopic mucosal resection. Dig Endosc. 2013; 26(1):63-8. DOI: 10.1111/den.12054. View

11.

Yoshida M, Goto N, Kawaguchi M, Koyama H, Kuroda J, Kitahora T . Initial clinical trial of a novel hemostat, TDM-621, in the endoscopic treatments of the gastric tumors. J Gastroenterol Hepatol. 2014; 29 Suppl 4:77-9. DOI: 10.1111/jgh.12798. View

12.

Tomizawa Y, Ginsberg G . Clinical outcome of EMR of sporadic, nonampullary, duodenal adenomas: a 10-year retrospective. Gastrointest Endosc. 2018; 87(5):1270-1278. DOI: 10.1016/j.gie.2017.12.026. View

13.

Mourad F, Leong R . Role of hemostatic powders in the management of lower gastrointestinal bleeding: A review. J Gastroenterol Hepatol. 2018; 33(8):1445-1453. DOI: 10.1111/jgh.14114. View

14.

Facciorusso A, Antonino M, Di Maso M, Muscatiello N . Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis. World J Gastrointest Endosc. 2014; 6(11):555-63. PMC: 4231495. DOI: 10.4253/wjge.v6.i11.555. View

15.

Yang D, Zou F, Xiong S, Forde J, Wang Y, Draganov P . Endoscopic submucosal dissection for early Barrett's neoplasia: a meta-analysis. Gastrointest Endosc. 2017; 87(6):1383-1393. DOI: 10.1016/j.gie.2017.09.038. View

16.

Bahin F, Naidoo M, Williams S, Hourigan L, Ormonde D, Raftopoulos S . Prophylactic endoscopic coagulation to prevent bleeding after wide-field endoscopic mucosal resection of large sessile colon polyps. Clin Gastroenterol Hepatol. 2014; 13(4):724-30.e1-2. DOI: 10.1016/j.cgh.2014.07.063. View

17.

Dong J, Wei K, Deng J, Zhou X, Huang X, Deng M . Effects of antithrombotic therapy on bleeding after endoscopic submucosal dissection. Gastrointest Endosc. 2017; 86(5):807-816. DOI: 10.1016/j.gie.2017.07.017. View

18.

Navaneethan U, Hasan M, Lourdusamy V, Zhu X, Hawes R, Varadarajulu S . Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review. Endosc Int Open. 2016; 4(6):E699-708. PMC: 4993908. DOI: 10.1055/s-0042-107069. View

19.

Nishizawa T, Suzuki H, Goto O, Ogata H, Kanai T, Yahagi N . Effect of prophylactic clipping in colorectal endoscopic resection: A meta-analysis of randomized controlled studies. United European Gastroenterol J. 2017; 5(6):859-867. PMC: 5625873. DOI: 10.1177/2050640616687837. View

20.

Masuhara H, Fujii T, Watanabe Y, Koyama N, Tokuhiro K . Novel infectious agent-free hemostatic material (TDM-621) in cardiovascular surgery. Ann Thorac Cardiovasc Surg. 2012; 18(5):444-51. DOI: 10.5761/atcs.oa.12.01977. View