Endosc Int Open 2016; 04(04): E415-E419
DOI: 10.1055/s-0042-102879
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A self-assembling matrix-forming gel can be easily and safely applied to prevent delayed bleeding after endoscopic resections

Mathieu Pioche
1  Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France
2  INSERM U1032, Lyon, France
3  University Claude Bernard Lyon 1, Lyon, France
,
Marine Camus
4  Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France
5  University Paris V Descartes, Paris, France
,
Jérôme Rivory
1  Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France
,
Sarah Leblanc
4  Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France
,
Isabelle Lienhart
1  Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France
,
Maximilien Barret
4  Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France
5  University Paris V Descartes, Paris, France
,
Stanislas Chaussade
4  Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France
5  University Paris V Descartes, Paris, France
,
Jean-Christophe Saurin
1  Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France
3  University Claude Bernard Lyon 1, Lyon, France
,
Frederic Prat
4  Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France
5  University Paris V Descartes, Paris, France
,
Thierry Ponchon
1  Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France
2  INSERM U1032, Lyon, France
3  University Claude Bernard Lyon 1, Lyon, France
› Author Affiliations
Further Information

Publication History

submitted 04 November 2015

accepted after revision 29 January 2016

Publication Date:
30 March 2016 (online)

Background: Endoscopic resections have low morbidity and mortality. Delayed bleeding has been reported in approximately 1 – 15 % of cases, increasing with antiplatelet/anticoagulant therapy or portal hypertension. A self-assembling peptide (SAP) forming a gel could protect the mucosal defect during early healing. This retrospective trial aimed to assess the safety and efficacy of SAP in preventing delayed bleeding after endoscopic resections.

Methods: Consecutive patients with endoscopic resections were enrolled in two tertiary referral centers. Patients with a high risk of bleeding (antiplatelet agents, anticoagulation drugs with heparin bridge therapy, and cirrhosis with portal hypertension) were also included. The SAP gel was applied immediately after resection to cover the whole ulcer bed.

Results: In total, 56 patients were included with 65 lesions (esophagus [n = 8], stomach [n = 22], duodenum [n = 10], ampullary [n = 3], colon [n = 7], and rectum [n = 15]) in two centers. Among those 65 lesions, 29 were resected in high risk situations (9 uninterrupted aspirin therapy, 6 heparin bridge therapies, 5 cirrhosis and portal hypertension, 1 both cirrhosis and heparin bridge, 3 both cirrhosis and uninterrupted aspirin, 3 large duodenal lesions > 2 cm, and 2 early introduction of clopidogrel at day 1). The resection technique was endoscopic submucosal dissection (ESD) in 40 cases, en bloc endoscopic mucosal resection (EMR) in 16, piecemeal EMR in 6, and ampullectomy in 3. The mean lesion size was 37.9 mm (SD: 2.2 mm) with a mean area of 6.3 cm2 (SD: 3.5 cm2). No difficulty was noted during application. Four delayed overt bleedings occurred (6.2 %) (3 hematochezia, 1 hematemesis) requiring endoscopic hemostasis. The mean hemoglobin drop off was 0.6 g/dL (– 0.6 to 3.1 g/dL). No adverse events occurred.

Conclusion: The use of this novel extracellular matrix scaffold may help to reduce post-endoscopic resection bleedings including in high risk situations. Its use is easy and safe but further comparative studies are warranted to completely evaluate its effectiveness.