NOVEL ENDOSCOPIC TOOL TO PREVENT DELAYED BLEEDING AFTER WIDE ENDOSCOPIC RESECTIONS IN HIGH RISK PATIENTS: AN INITIAL SINGLE-CENTRE EXPERIENCE

Aims:

High-risk endoscopic procedures, like endoscopic mucosal resection (EMR) and submucosal dissection (ESD) are associated with a potential risk of bleeding requiring further interventions, like hospitalization, transfusion, endoscopic treatment or surgery. The incidence after polypectomy ranges up to 10% and can be displayed until 1 month after the procedure. Many factors are involved, for example polyp size, location, morphology, resection technique type of cautery used and ongoing antiplatelet and/or antithrombotic agents. Self-assembling peptide (SAP, Purastat®, 3D Matrix, Ltd, Tokyo, Japan) forming an hemostatic gel under appropriate conditions of ionization, protecting mucosal defects during the early phase of healing, also preventing stenosis, has been recently available.

Methods:

We prospectively collected and retrospectively analysed 7 consecutive patients referred to our Unit to underwent resection of polypoid or non-polypoid lesion of the digestive tract (2 in the ascending colon, 1 in the sigmoid tract, 2 in the rectum, 1 in the stomach).

Results:

All these 7 lesions were large (≥25 mm) and resected in high risk situations: 4 uninterrupted antiplatelet therapy (2 previously in double antiplatelet treatment),3 low-molecular weight heparin bridge therapies followed by anticoagulant drugs at day 7. The resection technique was piecemeal EMR in 3 cases (2 lesions in the ascending colon and 1 in the sigmoid tract), mixed technique ESD/EMR in the 3 rectal lesions, 1 ESD in the stomach. All previous lifting of the submucosal layer with dedicated solution containing diluted epinephrine (1:100000). After all procedures, the resection bed was carefully examined and prophylactic hemostasis of visible vessels was firstly performed with monopolar forceps (Co-Agrasper, Olympus LTD, Tokyo, Japan) and subsequently using PuraStat 3 ml to cover the whole resected area.

In 1 case, mild intra-procedural bleeding occurred, promptly resolved by monopolar forcep and PuraStat. At 30-days follow-up, none delayed post-procedural bleeding were registered.

Conclusions:

In conclusion, the new hemostatic hydrogel Purastat® seems promising in preventing delayed post-procedural bleeding in high risk patients, even if in initial experience. However, this non-comparative study cannot fully evaluate its efficacy, thus randomized controlled trials are needed in order to recommend it as standard practice.