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]).
Fig. 1 Suspected bleeding on the oral side (duodenoscope TJF-260V; Olympus, Tokyo, Japan).
Fig. 2 Limited visual field due to blood accumulating in the diverticulum (gastroscope GIF-H290T;
Olympus, Tokyo, Japan).
Fig. 3 Primary hemostasis with PuraStat (3-D Matrix Ltd., Tokyo, Japan).
Fig. 4 Primary hemostasis allowed a good visual field and vascular identification.
Fig. 5 Hemostasis was achieved with a clip.
PuraStat (3-D Matrix Ltd., Tokyo, Japan) may offer a new strategy for managing duodenal
diverticular hemorrhage.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.
Endoscopy_UCTN_Code_TTT_1AO_2AD
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