PURASTAT A NEW HEMOSTATIC DEVICE TO CONTROL MASSIVE GI BLEEDINGS: A DUAL CENTRE CASE SERIES

Aims:

Gastrointestinal (GI) bleeding from upper and the lower GI tract is a common cause for hospitalization, resulting in significant mortality and morbidity, Recently innovative topical hemostatic modalities have been developed for endoscopic use.

Our aim is to demostrate the usefulness, feasibility and safety of Purastat to control GI bleedings. Puramatrix is a synthetic, bioresorbable material and is used to produce Purastat, a gel used in GI endoscopy to control venous/arteriolar bleedings, preventing blood from escaping, helping the creation of a stable clot. It's very easy, quick and trasparent allowing to continue the procedure or to use other haemostatic therapies in addiction.

Methods:

We report a case series of 10 patients (6 male, 4 women, median age 67 years) recovered to our endoscopy unit for GI bleedings after the failure of traditional hemostatic strategies (injection and/or clipping). In particular 6 patients out of 10, presented with lower GI haemorrhage from an oozing site after mucosectomy for non polypoid colon adenomas in different sites of the colon, 1 patient showed melena an ipothension for duodenal bleeding from bulbar kissing ulcers, 1 patient had emathemesis and melena after Vater papilla's sphincterotomy, 1 patient showed progressive anemization for bleeding inside a psedocyst after endoscopy ultrasound guided drainage and 1 patient presented with a massive rectal bleeding after a prostatic biopsy.

Results:

We tried to achieve a successfull hemostasis first of all using an adrenaline injection (diuited with saline solution 1:10.000) and subsequently with clipping and/or argon plasma coagulator application without success. Finally we used a strate of Purastat applying 3 ml of gel, achieving a successfull, stable hemostasis with a complete patients recovery in few days after the procedure, no pain and haemodinamical stability.

Conclusions:

Purastat is a novel, safe and feasible hemostatic device capable to control different types of GI haemorrhages even if the arteriolar massive ones.