Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(05): E553-E560
DOI: 10.1055/a-2057-4505
Original article

Efficacy of self-assembling peptide in mitigating delayed bleeding after advanced endoscopic resection of gastrointestinal lesions: A meta-analysis

Harishankar Gopakumar 
1   Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
,
Ishaan Vohra 
1   Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
,
Neil R. Sharma
2   Parkview Cancer Institute, Interventional Oncology & Surgical Endoscopy (IOSE) division, GI Oncology Tumor Site Team, Fort Wayne, Indiana, United States
,
Srinivas R. Puli
1   Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Advanced endoscopic resection techniques carry a risk of delayed bleeding (DB). A novel fully synthetic self-assembling peptide (SAP) has shown promising results in mitigating this risk. In this meta-analysis, we evaluated all available data and analyzed the effectiveness of SAP in reducing DB after advanced endoscopic resection of gastrointestinal luminal lesions.

Patients and methods Electronic databases (PubMed, Embase, and Cochrane Library) from January 2010 through October 2022 were searched for publications addressing the use of SAP solution in patients undergoing advanced endoscopic resection of gastrointestinal lesions. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models.

Results The initial search identified 277 studies, of which 63 relevant articles were reviewed. The final analysis included data from six studies comprising 307 patients that met inclusion criteria. The pooled rate of DB was 5.73 % (95 % confidence interval [CI] = 3.42–8.59). Mean patient age was 69.40 years ± 1.82. The weighted mean size of resected lesions was 36.20 mm (95 % CI = 33.37–39.02). Endoscopic submucosal dissection was used in 72.69 % (95 % CI = 67.62–77.48), while endoscopic mucosal resection was used in 26.42 % (95 % CI = 21.69–31.44) of the procedures. Among the 307 patients, 36 % were on antithrombotic medications. No adverse events (AEs) were attributable to using SAP, with a pooled rate of 0.00 % (95 % CI = 0.00–1.49).

Conclusions SAP solution appears promising in reducing post-procedural DB after advanced endoscopic resection of high-risk gastrointestinal lesions with no reported AEs.



Publication History

Received: 27 October 2022

Accepted after revision: 22 February 2023

Accepted Manuscript online:
17 March 2023

Article published online:
26 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ahmed Y, Othman M. EMR/ESD: Techniques, complications, and evidence. Curr Gastroenterol Rep 2020; 22: 39
    CrossrefPubMedGoogle Scholar
  • 2 Kataoka Y, Tsuji Y, Sakaguchi Y. et al. bleeding after endoscopic submucosal dissection: Risk factors and preventive methods. World J Gastroenterol 2016; 22: 5927-5935
    CrossrefPubMedGoogle Scholar
  • 3 Libânio D, Costa MN, Pimentel-Nunes P. et al. Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis. Gastrointest Endosc 2016; 84: 572-586
    CrossrefPubMedGoogle Scholar
  • 4 Suzuki S, Chino A, Kishihara T. et al. Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms. World J Gastroenterol 2014; 20: 1839-1845
    CrossrefPubMedGoogle Scholar
  • 5 Nishizawa T, Suzuki H, Goto O. et al. Effect of prophylactic clipping in colorectal endoscopic resection: A meta-analysis of randomized controlled studies. United European Gastroenterol J 2017; 5: 859-867
    CrossrefPubMedGoogle Scholar
  • 6 Pohl H, Grimm IS, Moyer MT. et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 2019; 157: 977-984.e3
    CrossrefPubMedGoogle Scholar
  • 7 Feagins LA, Smith AD, Kim D. et al. efficacy of prophylactic hemoclips in prevention of delayed post-polypectomy bleeding in patients with large colonic polyps. Gastroenterology 2019; 157: 967-976.e1
    CrossrefPubMedGoogle Scholar
  • 8 Sankar S, O'Neill K, Bagot D'Arc M. et al. Clinical use of the self-assembling peptide rada16: a review of current and future trends in biomedicine. Front Bioeng Biotechnol 2021; 9: 679525
    CrossrefPubMedGoogle Scholar
  • 9 Yoshida M, Goto N, Kawaguchi M. et al. Initial clinical trial of a novel hemostat, TDM-621, in the endoscopic treatments of the gastric tumors. J Gastroenterol Hepatol 2014; 29: 77-79
    CrossrefPubMedGoogle Scholar
  • 10 Pioche M, Camus M, Rivory J. et al. A self-assembling matrix-forming gel can be easily and safely applied to prevent delayed bleeding after endoscopic resections. Endosc Int Open 2016; 4: E415-E419
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Uraoka T, Ochiai Y, Fujimoto A. et al. A novel fully synthetic and self-assembled peptide solution for endoscopic submucosal dissection-induced ulcer in the stomach. Gastrointest Endosc 2016; 83: 1259-1264
    CrossrefPubMedGoogle Scholar
  • 12 Subramaniam S, Kandiah K, Thayalasekaran S. et al. Haemostasis and prevention of bleeding related to ER: The role of a novel self-assembling peptide. United European Gastroenterol J 2019; 7: 155-162
    CrossrefPubMedGoogle Scholar
  • 13 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
    Google Scholar
  • 14 Soons E, Turan A, van Geenen E. et al. Application of a novel self-assembling peptide to prevent hemorrhage after EMR, a feasibility and safety study. Surg Endosc 2021; 35: 3564-3571
    CrossrefPubMedGoogle Scholar
  • 15 Lee HD, Lee E, Kim SG. et al. A randomized, controlled trial of fibrin glue to prevent bleeding after gastric endoscopic submucosal dissection. Am J Gastroenterol 2022; DOI: 10.14309/ajg.0000000000002172.
    CrossrefPubMedGoogle Scholar
  • 16 Iizuka T, Kikuchi D, Hoteya S. Outcomes of endoscopic submucosal dissection for superficial esophageal cancer in an elderly population: a retrospective single center cohort study. Endosc Int Open 2019; 7: E355-E360
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Oza K, Peesay T, Greenspun B. et al. Long-term outcomes of endoscopic mucosal resection for early-stage esophageal adenocarcinoma. Surg Endosc 2022; 36: 5136-5143
    CrossrefPubMedGoogle Scholar
  • 18 Navaneethan U, Hasan MK, Lourdusamy V. et al. Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review. Endosc Int Open 2016; 4: E699-E708
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Lépilliez V, Chemaly M, Ponchon T. et al. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 2008; 40: 806-810
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Horie Y, Horiuchi Y, Ishiyama A. et al. The effect of antithrombotic drug use on delayed bleeding with esophageal endoscopic resection. J Gastroenterol Hepatol 2022; 37: 1792-1800
    CrossrefPubMedGoogle Scholar
  • 21 Miura Y, Tsuji Y, Yoshio T. et al. Association between perioperative management of antiplatelet agents and risk of post-endoscopic submucosal dissection bleeding in early gastric cancer: an analysis of a nationwide multicenter study. Gastrointest Endosc 2023; DOI: 10.1016/j.gie.2022.12.025.
    CrossrefPubMedGoogle Scholar
  • 22 Facciorusso A, Antonino M, Di Maso M. et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis. World J Gastrointest Endosc 2014; 6: 555-563
    CrossrefPubMedGoogle Scholar
  • 23 Lian J, Chen S, Zhang Y. et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 2012; 76: 763-770
    CrossrefPubMedGoogle Scholar
  • 24 Park YM, Cho E, Kang HY. et al. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and meta-analysis. Surg Endosc 2011; 25: 2666-2677
    CrossrefPubMedGoogle Scholar
  • 25 Kim MJ, Na SY, Kim JS. et al. Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a multicenter randomized controlled trial. Surg Endosc 2023; DOI: 10.1007/s00464-023-09875-1.
    CrossrefPubMedGoogle Scholar
  • 26 Burgess NG, Metz AJ, Williams SJ. et al. Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol 2014; 12: 651-61.e613
    CrossrefPubMedGoogle Scholar
  • 27 Burgess NG, Williams SJ, Hourigan LF. et al. A management algorithm based on delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol 2014; 12: 1525-1533
    CrossrefPubMedGoogle Scholar
  • 28 Turan AS, Moons LMG, Schreuder RM. et al. Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial. Trials 2021; 22: 63
    CrossrefPubMedGoogle Scholar
  • 29 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86.e17
    CrossrefPubMedGoogle Scholar
  • 30 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
    CrossrefPubMedGoogle Scholar
  • 31 Tanaka S, Tamegai Y, Tsuda S. et al. Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan. Dig Endosc 2010; 22: S2-S8
    CrossrefPubMedGoogle Scholar
  • 32 Takeuchi Y, Iishi H, Tanaka S. et al. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis 2014; 29: 1275-1284
    CrossrefPubMedGoogle Scholar
  • 33 Ogiyama H, Inoue T, Maekawa A. et al. Effect of anticoagulants on the risk of delayed bleeding after colorectal endoscopic submucosal dissection. Endosc Int Open 2020; 8: E1654-E1663
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Bahin FF, Naidoo M, Williams SJ. et al. Prophylactic endoscopic coagulation to prevent bleeding after wide-field endoscopic mucosal resection of large sessile colon polyps. Clin Gastroenterol Hepatol 2015; 13: 724-30.e1-2
    CrossrefPubMedGoogle Scholar
  • 35 Giritharan S, Salhiyyah K, Tsang GM. et al. Feasibility of a novel, synthetic, self-assembling peptide for suture-line haemostasis in cardiac surgery. J Cardiothorac Surg 2018; 13: 68
    CrossrefPubMedGoogle Scholar
  • 36 Nahm CB, Popescu I, Botea F. et al. 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: 700-707
    CrossrefPubMedGoogle Scholar
  • 37 Friedland Y, Bagot d'Arc MBD, Ha J. et al. 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
    CrossrefPubMedGoogle Scholar