Systematic review of self-assembling peptides as topical agents for treatment and prevention of gastrointestinal bleeding

Aims Gastrointestinal bleeding is a significant and potentially lethal event. Recently, a new hemostatic, gel-forming, self-assembling peptide has become available (PuraStat). We aimed to conduct the first systematic review on efficiency and safety of self-assembling peptides in the treatment and prevention of bleeding in the gastrointestinal tract.

Methods An systematic search was conducted in a parallel, independent fashion in major electronic databases and in proceedings from major congresses. We considered eligible all prospective and retrospective studies describing the endoscopic use of self-assembling peptides for treatment or prevention of bleeding in the gastrointestinal tract. Primary outcomes were rates of successful initial hemostasis, delayed bleeding, and rebleeding. Secondary outcomes were adverse events, ease of use, quantity of substance required [1] [2] [3].

Results A total of 3 RCTs and 14 observational studies were retrieved for analysis. Overall success rate was 87.7% (38.1-100%), regardless of bleeding etiology or associated treatments. Rebleeding rates ranged from 0-16.2%, with an average of 4.7% and overall delayed bleeding rate was 5.02% (ranging from 0 to 15.91%). Only 3 adverse events were reported for a pooled number of 815 patients. The volume of gel required to achieve hemostasis was variable, based on purpose (hemostasis or prophylaxis) and type of bleeding (mean volume ranging from 0.43 to 3.7 ml). Most authors noted the ease of use of Purastat, mainly in a qualitative fashion based on user experience and satisfaction.

Conclusions Despite limited available data on use of self-assembling peptides in gastrointestinal endoscopy, our review suggests high efficiency and a good safety profile.

Conflicts of interest

Andrei Voiosu received a speaker fee from SofMedica/Fuji

• 1 Nahm CB, Popescu I, Botea F, Fenwick S, Fondevila C, Bilbao I, Reim D, Toogood GJ.. A multi-center post-market clinical study to confirm safety and performance of PuraStat in the management of bleeding during open liver resection. HPB (Oxford) 2022; 24 (05) 700-707 DOI: 10.1016/j.hpb.2021.09.020.. Epub 2021 Oct 6. PMID: 34674951
• 2 Friedland Y, d'Arc MBDBagot, 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: sti41/1594 DOI: 10.52198/22.STI.41.GS1694.. Epub ahead of print. PMID: 35556241
• 3 Laursen SB, Stanley AJ, Laine L, de Muckadell OB.Schaffalitzky. Rebleeding in peptic ulcer bleeding – a nationwide cohort study of 19,537 patients. Scand J Gastroenterol 2022; 1-7 DOI: 10.1080/00365521.2022.2098050.. Epub ahead of print. PMID: 35853234

Publication History

Article published online:
14 April 2023