Systematic Review of Self-assembling Peptides As Topical Agents for Treatment and Prevention of Gastrointestinal Bleeding

Overview

Journal Clin Endosc

Date 2024 Jun 26

PMID 38919060

Authors

Andrei Voiosu

Monica State

Victor Dragan

Sergiu Vaduva

Paul Balanescu

Radu Bogdan Mateescu

Theodor Voiosu

Affiliations

Soon will be listed here.

Abstract

Background/aims: Gastrointestinal bleeding is a significant and potentially lethal event. We aimed to review the efficiency and safety of self-assembling peptides for the treatment and prevention of gastrointestinal tract bleeding.

Methods: We conducted a systematic search for studies describing the endoscopic use of self-assembling peptides for treatment or prevention of bleeding in the gastrointestinal tract in a parallel, independent fashion. The primary outcomes were rates of successful initial hemostasis, delayed bleeding, and rebleeding. The secondary outcomes were adverse events and ease and volume of gel used.

Results: Seventeen studies were analyzed. Overall success rate of self-assembling peptides in gastrointestinal bleeding was 87.7% (38%-100%), regardless of etiology or associated treatments. Rebleeding rate ranged from 0% to 16.2%, with a mean of 4.7%, and overall delayed bleeding rate was 5% (range, 0%-15.9%). Only three adverse events were reported in a pooled number of 815 patients. The volume of gel used varied (0.43 to 3.7 mL) according to indication and type of bleeding.

Conclusions: The limited available data on the use of self-assembling peptides in gastrointestinal endoscopy suggest a high efficiency and good safety profile.

Citing Articles

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Higashino M, Murakami H, Hirata T, Miyaoka H DEN Open. 2024; 5(1):e70033.

PMID: 39563737 PMC: 11574666. DOI: 10.1002/deo2.70033.

References

Yang T, Wu Y, Lee P, Chang C, Lu H, Chen Y . Prophylactic clipping after endoscopic mucosal resection of large nonpedunculated colorectal lesions: A meta-analysis. J Gastroenterol Hepatol. 2021; 36(7):1778-1787. DOI: 10.1111/jgh.15472. 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

Rosenstock S, Moller M, Larsson H, Johnsen S, Madsen A, Bendix J . Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13,498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol. 2013; 108(9):1449-57. DOI: 10.1038/ajg.2013.162. View

Choi J, Cho I, Lee S, Kim J, Park N, Lee M . Efficacy and safety of novel hemostatic gel in endoscopic sphincterotomy or endoscopic papillectomy: A multicenter, randomized controlled clinical trial. Dig Liver Dis. 2023; 55(4):527-533. DOI: 10.1016/j.dld.2023.01.157. View

Chung I, Ham J, Kim H, Park S, Lee M, Kim S . Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc. 1998; 49(1):13-8. DOI: 10.1016/s0016-5107(99)70439-6. View

McWhinney C, Vemulapalli K, El Rahyel A, Abdullah N, Rex D . Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions ≥10 mm. Gastrointest Endosc. 2020; 93(3):654-659. DOI: 10.1016/j.gie.2020.08.032. View

Forbes N, Gupta S, Frehlich L, Meng Z, Ruan Y, Montori S . Clip closure to prevent adverse events after EMR of proximal large nonpedunculated colorectal polyps: meta-analysis of individual patient data from randomized controlled trials. Gastrointest Endosc. 2022; 96(5):721-731.e2. DOI: 10.1016/j.gie.2022.05.020. View

Chen B, Du L, Luo L, Cen M, Kim J . Prophylactic clips to reduce delayed polypectomy bleeding after resection of large colorectal polyps: a systematic review and meta-analysis of randomized trials. Gastrointest Endosc. 2020; 93(4):807-815. DOI: 10.1016/j.gie.2020.10.004. View

Soons E, Turan A, van Geenen E, Siersema P . Application of a novel self-assembling peptide to prevent hemorrhage after EMR, a feasibility and safety study. Surg Endosc. 2020; 35(7):3564-3571. PMC: 8195920. DOI: 10.1007/s00464-020-07819-7. View

10.

Chandrasekar V, Desai M, Aziz M, Patel H, Gorrepati V, Jegadeesan R . Efficacy and safety of over-the-scope clips for gastrointestinal bleeding: a systematic review and meta-analysis. Endoscopy. 2019; 51(10):941-949. DOI: 10.1055/a-0994-4361. View

11.

Misumi Y, Nonaka K . Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection. J Clin Med. 2021; 10(11). PMC: 8201364. DOI: 10.3390/jcm10112511. View

12.

Parsi M, Schulman A, Aslanian H, Bhutani M, Krishnan K, Lichtenstein D . Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos). VideoGIE. 2019; 4(7):285-299. PMC: 6616320. DOI: 10.1016/j.vgie.2019.02.004. View

13.

Branchi F, Klingenberg-Noftz R, Friedrich K, Burgel N, Daum S, Buchkremer J . PuraStat in gastrointestinal bleeding: results of a prospective multicentre observational pilot study. Surg Endosc. 2021; 36(5):2954-2961. PMC: 9001238. DOI: 10.1007/s00464-021-08589-6. View

14.

Mutneja H, Bhurwal A, Go A, Sidhu G, Arora S, Attar B . Efficacy of Hemospray in Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. J Gastrointestin Liver Dis. 2020; 29(1):69-76. DOI: 10.15403/jgld-660. View

15.

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

16.

Friedland Y, Bagot dArc M, Ha J, Delin C . The Use of Self-Assembling Peptides (PuraStat™) in Functional Endoscopic Sinus Surgery for Haemostasis and Reducing Adhesion Formation. A Case Series of 94 Patients. Surg Technol Int. 2022; 41:105-110. DOI: 10.52198/22.STI.41.GS1694. View

17.

Cryer B, Wilcox C, Henk H, Zlateva G, Chen L, Zarotsky V . The economics of upper gastrointestinal bleeding in a US managed-care setting: a retrospective, claims-based analysis. J Med Econ. 2010; 13(1):70-7. DOI: 10.3111/13696990903526676. View

18.

Voiosu A . Commentary. Endoscopy. 2022; 54(12):1234-1235. DOI: 10.1055/a-1899-3834. View

19.

Hamada S, Teramoto A, Zukeyama R, Matsukawa S, Fukuhara T, Takaki R . Efficacy of Combination Therapy with Epinephrine Local Injection and Hemostatic Clips on Active Diverticular Bleeding. J Clin Med. 2022; 11(17). PMC: 9457277. DOI: 10.3390/jcm11175195. View

20.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J . Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73(9):712-6. DOI: 10.1046/j.1445-2197.2003.02748.x. View