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DOI: 10.1055/a-2655-4479
Hemostasis achieved with new self-assembling peptide hemostatic gel for a bleeding duodenal diverticulum
Authors
Endoscopic hemostasis of parapapillary diverticular hemorrhage is challenging due to poor visualization caused by blood pooling and difficulty with endoscope manipulation. There have been reports of cases that required interventional radiology or surgical treatment. Recently, a new self-assembling peptide hemostatic gel (PuraStat; 3-D Matrix Ltd., Tokyo, Japan) has become available for treatment of gastrointestinal bleeding [1] [2]. We report the first case of hemostasis achieved with PuraStat for a bleeding duodenal diverticulum.
A 75-year-old man receiving aspirin therapy presented to the emergency department with hematemesis. Upper gastrointestinal endoscopy revealed active hemorrhage in the diverticulum near the duodenal papilla ([Fig. 1]). Persistent venous hemorrhage rapidly resulted in blood pooling within the parapapillary diverticulum ([Fig. 2]). Electrocoagulation could not be performed due to the risk of perforation. We utilized 3 mL of PuraStat to fill the diverticulum for primary hemostasis ([Fig. 3]). After a few minutes, the active bleeding subsided, permitting the identification of the exposed blood vessel ([Fig. 4]). The vessel was secured using a reopenable clip ([Fig. 5]), and complete hemostasis was achieved without complications ([Video 1]).
PuraStat reduced the bleeding and ensured a clear visual field, resulting in endoscopic hemostasis. PuraStat was deemed beneficial as a potential hemostatic treatment for parapapillary diverticulum hemorrhage, especially in active bleeding where maintaining visual clarity is difficult. PuraStat should be considered in emergency endoscopic hemostasis of parapapillary diverticulum bleeding.
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Publikationsverlauf
Artikel online veröffentlicht:
08. August 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Branchi F, Klingenberg-Noftz R, Friensrich K. et al. PuraStat in gastrointestinal bleeding: results of a prospective multicentre observational pilot study. Surg Endosc 2022; 36: 2954-2961
- 2 Murakami T, Kamba E, Haga K. et al. Emergency endoscopic hemostasis for gastrointestinal bleeding using a self-assembling peptide: a case series. Medicina (Kaunas) 2023; 59: 931