Use of a self-assembling peptide to control complications associated with endoscopic balloon dilation of refractory anastomotic stricture

PuraStat (3-D Matrix, Tokyo, Japan) is a novel self-assembling peptide hydrogel developed as a hemostatic agent that is believed to be effective in reducing the risk of delayed perforation due to excessive cautery burns [1] [2] [3]. Additionally, studies in animal models have suggested the potential of PuraStat for preventing esophageal strictures after endoscopic submucosal dissection for esophageal cancer [4] [5]. In this report, we present a case in which the self-assembling peptide gel effectively managed esophageal stricture and safely addressed complications related to endoscopic balloon dilation (EBD) ([Video 1]).

A self-assembling peptide hydrogel is used to control complications associated with endoscopic balloon dilation of refractory anastomotic stricture.Video 1

The patient was a 71-year-old man who developed a severe anastomotic stricture after esophagogastrostomy for esophageal cancer. EBD for the stenosis was performed repeatedly every 2 months after surgery, but no improvement was observed ([Fig. 1] a).

Fig. 1 a Anastomotic stricture following esophagogastrostomy. b The stricture was dilated to 12 mm (8 atm) using EBD. c Identification of the bleeding source was challenging.

The 23rd EBD was performed to 12 mm (8 atm) using multistage dilation balloons (Micro-Tech, Nanjing, China) as usual ([Fig. 1] b). Immediately after deflation, active bleeding was observed. The bleeding source was on the posterior wall and submerged due to gravity which made it difficult to identify; the wound appeared to be deep ([Fig. 1] c). Given the complexity and risk of alternative hemostasis methods, we applied PuraStat achieving hemostasis in approximately 1 minute ([Fig. 2]).

Fig. 2 a Application of PuraStat self-assembling peptide hydrogel allows simultaneous visualization and hemostasis (arrows). b Application of pressure at the bleeding site to create a bulge. c Complete cessation of bleeding within approximately 1 minute.

Despite the persistent and challenging nature of the stricture, it gradually improved, and the frequency of EBD procedures decreased significantly after the introduction of PuraStat. The use of PuraStat as a wound dressing during EBD procedures appeared to enhance esophageal wound healing, delaying the stricture formation process ([Fig. 3]).

Fig. 3 Gradual improvement of the stricture following the use of the self-assembling peptide hydrogel. a Before application. b After introduction of PuraStat.

In conclusion, our experience indicates that PuraStat may contribute to the prevention of re-stenosis after EBD for refractory postoperative stricture. PuraStat is suggested to be a valuable and safe option for managing not only bleeding prevention but also postoperative stricture.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Subramaniam S, Kandiah K, Chedgy F. et al. A novel self-assembling peptide for hemostasis during endoscopic submucosal dissection: a randomized controlled trial. Endoscopy 2021; 53: 27-35
• 2 Uraoka T, Uedo N, Oyama T. et al. Efficacy and safety of a novel hemostatic peptide solution during endoscopic submucosal dissection: a multicenter randomized controlled trial. Am J Gastroenterol 2023; 118: 276-283
• 3 Jung D, Youn YH, Jahng J. et al. Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Endoscopy 2013; 45: 714-717
• 4 Barret M, Bordaçahar B, Beuvon F. et al. Self-assembling peptide matrix for the prevention of esophageal stricture after endoscopic resection: a randomized controlled trial in a porcine model. Dis Esophagus 2017; 30: 1-7
• 5 Oumrani S, Barret M, Bordaçahar B. et al. Application of a self-assembling peptide matrix prevents esophageal stricture after circumferential endoscopic submucosal dissection in a pig model. PLoS One 2019; 14: e0212362

Publication History

Article published online:
14 March 2024