Endoscopy
DOI: 10.1055/a-1145-3412
Original article

Efficacy of a novel self-assembling peptide hemostatic gel as rescue therapy for refractory acute gastrointestinal bleeding

Germana de Nucci
1  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Garbagnate Milanese, Milan, Italy
,
Raffaella Reati
1  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Garbagnate Milanese, Milan, Italy
,
Ilaria Arena
2  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Rho Hospital, Milan, Italy
,
Cristina Bezzio
2  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Rho Hospital, Milan, Italy
,
Massimo Devani
2  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Rho Hospital, Milan, Italy
,
Cristina della Corte
2  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Rho Hospital, Milan, Italy
,
Daniela Morganti
1  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Garbagnate Milanese, Milan, Italy
,
Enzo Domenico Mandelli
1  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Garbagnate Milanese, Milan, Italy
,
Barbara Omazzi
2  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Rho Hospital, Milan, Italy
,
Davide Redaelli
1  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Garbagnate Milanese, Milan, Italy
,
Simone Saibeni
2  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Rho Hospital, Milan, Italy
,
Marco Dinelli
3  Endoscopy Unit, San Gerardo Hospital, Monza, Italy
,
Gianpiero Manes
1  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Garbagnate Milanese, Milan, Italy
2  Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense – Rho Hospital, Milan, Italy
› Author Affiliations

Abstract

Background Acute gastrointestinal bleeding (AGIB) results in significant morbidity and mortality. Topical hemostatic products have been developed for endoscopic use to help in the management of difficult bleeding. Our aim was to demonstrate the ease of use, safety, and efficacy of PuraStat, a novel hemostat, to control AGIB.

Methods We describe 77 patients (41 men) who were treated for acute upper and lower AGIB in a 2-year period. In 50 patients, bleeding occurred as a complication of a previous endoscopic procedure, predominantly endoscopic mucosal resection (EMR) and endoscopic retrograde cholangiopancreatography (ERCP); however, in the other 27 patients, it derived from peptic ulcers, angiodysplasia, cancers, and surgical anastomoses. Bleeding was spurting in 13 of the 77 patients and oozing in 64. PuraStat was used after the failure of at least two conventional hemostatic methods.

Results A mean of 2.6 conventional hemostatic methods had been attempted prior to the application of PuraStat. PuraStat achieved successful hemostasis in 90.9 % of patients. In 41 patients, once hemostasis was obtained with PuraStat, endoscopists further stabilized hemostasis by using at least one additional method. Recurrence of bleeding was observed in eight patients (10.4 %). In 16 patients with intraprocedural bleeding, it was possible to complete the procedures (14 EMR, 2 ERCP) after PuraStat hemostasis. No adverse events related to PuraStat were recorded.

Conclusions PuraStat is feasible, safe, and effective in controlling different types of gastrointestinal hemorrhage after failure of conventional hemostatic methods. Its application also does not hinder continuing endotherapy.



Publication History

Received: 23 December 2019

Accepted: 10 March 2020

Publication Date:
21 April 2020 (online)

© Georg Thieme Verlag KG
Stuttgart · New York