EFFICACY OF PURASTAT AS A RESCUE THERAPY FOR REFRACTORY ACUTE GASTROINTESTINAL BLEEDINGS: A THREE CENTRE EXPERIENCE IN ITALY

Aims Acute gastrointestinal bleeding (AGIB) results in significant mortality and morbidity. Topical haemostatic products have been developed for endoscopic use to help in the management of difficult bleeding. Our aim is to demonstrate the feasibility, efficacy and safety of PuraStat, a novel haemostat, to control acute gastrointestinal bleedings

Methods We describe 45 patients (25 males) treated for acute upper and lower AGIB in a 12 months period. In 32 patients bleeding occurred as a complication of a previous endoscopic procedure, mainly EMR and ERCP, while in 13 it derived from peptic ulcers, angiodysplasia, leiomyoma and surgical anastomosis.Bleeding was spurting in 7 cases and oozing in 38. PuraStat was used after the failure of at least two conventional haemostatic methods.

Results A mean of 2.7 haemostatic methods were attempted prior to inject PuraStat. Application of PuraStat achieved successful haemostasis in 93.3% of cases. In 20 patients, once haemostasis was obtained by PuraStat, endoscopist stabilized haemostasis by using at least one further method. Recurrence of bleeding was observed in 8.9% of cases. In 10 patients with intraprocedural bleeding, the procedures (9 EMR and 1 ERCP) were completed following PuraStat haemostasis. No adverse events related to PuraStat were recorded.

Conclusions PuraStat is feasible, effective and safe in controlling different types of gastrointestinal haemorrhages after failure of current haemostatic methods. Its application does not hinder continuing endotherapy