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Endoscopy 2021; 53(01): 27-35
DOI: 10.1055/a-1198-0558
Original article

A novel self-assembling peptide for hemostasis during endoscopic submucosal dissection: a randomized controlled trial

Sharmila Subramaniam
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
,
Kesavan Kandiah
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
2   Department of Gastroenterology, St George's University Hospital NHS Trust, London, UK
,
Fergus Chedgy
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
3   Department of Gastroenterology, Brighton and Sussex University Hospitals NHS Trust, Brighton and Hove, UK
,
Carole Fogg
4   Department of Research and Innovation, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
5   School of Health Sciences, University of Southampton, Southampton, UK
,
Sreedhari Thayalasekaran
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
,
Asma Alkandari
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
,
Michelle Baker-Moffatt
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
,
Joanne Dash
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
,
Mark Lyons-Amos
4   Department of Research and Innovation, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
,
Gaius Longcroft-Wheaton
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
6   School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
,
James Brown
6   School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
,
Pradeep Bhandari
1   Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
6   School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT02833558 Type of study: randomised controlled trial
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Author commentary on Sharmila Subramaniam et al.Endoscopy 2021; 53(01): v1-v1
DOI: 10.1055/a-1216-3055

Abstract

Background Endoscopic submucosal dissection (ESD) is associated with a risk of bleeding. Bleeding is usually treated with diathermy, although this does carry a risk of mucosal thermal injury. Purastat is a topical hemostat that may be effective in controlling bleeding during ESD, thereby reducing the use of heat therapy. The aim of this study was to assess the reduction in heat therapy used in the interventional group (Purastat) compared with the control group. The secondary aims were to compare the procedure length, time for hemostasis, delayed bleeding rate, adverse events, and wound healing between the groups.

Methods This was a single-center randomized controlled trial of 101 patients undergoing ESD. Participants were randomized to a control group where diathermy was used to control bleeding or an interventional group where Purastat could be used. Follow-up endoscopy was performed at 4 weeks to assess wound healing.

Results There was a significant reduction in the use of heat therapy for intraprocedural hemostasis in the interventional group compared with controls (49.3 % vs. 99.6 %, P < 0.001). There were no significant differences in the procedure length, time for hemostasis, and delayed bleeding rate between the groups. Complete wound healing at 4 weeks was noted in 48.8 % of patients in the interventional group compared with 25.0 % of controls (P = 0.02).

Conclusions This study has demonstrated that Purastat is an effective hemostat that can reduce the need for heat therapy for bleeding during ESD. It may also have a role in improving post-resection wound healing.



Publication History

Received: 29 October 2019

Accepted: 06 May 2020

Article published online:
17 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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