Collagen/Povidone as a New Endoscopic Treatment Option in Peptic Ulcer Bleeding

Table of Contents

We report here on a case of recurrent bleeding secondary to duodenal ulcer, despite previous endoscopic treatment with epinephrine and argon, which was controlled with endoscopic injection of collagen/povidone. This is a biological agent derived from gamma-irradiation of a mixture of type I pepsinated porcine collagen and povidone that has been reported to improve recovery during the healing process [1] [2].

A 63-year-old man with history of chronic use of nonsteroidal anti-inflammatory drugs presented with hematemesis and melena. Endoscopic examination revealed a large ulcer in the second portion of the duodenum, with two visible vessels, which were sclerosed with 1 : 10 000 epinephrine and argon. Nine days after this procedure, the patient had a new bleeding event, with the same endoscopic features (Figure [1]), and received the same treatment. Hemoclips were not used, as almost the entire surface of the extensive lesion was thickened and bleeding, so that clips could not be attached. After 2 days, in view of continuing bleeding, it was decided to administer 4 ml of collagen/povidone in 10 ml of distilled water through the endoscope, injecting 3 ml into the lesion and 7 ml on the surface. Significant improvement in the lesion was observed 24 h after the collagen/povidone injection (Figure [2]). Notable healing was evident 72 h later, and there was no subsequent bleeding.

Figure 1 a Recurrent bleeding, b sclerosed with epinephrine and argon.

Figure 2 a, b The endoscopic appearance 24 h after treatment with collagen-povidone.

In this particular case, collagen-povidone proved to be a good treatment option, and controlled studies of it as a new sclerosant agent may be worth considering.

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References

• 1 Almazán D A, De la Cruz G JC, Lira R JM. et al . Investigación experimental de la regeneración ósea en fémures de rata después de la aplicación de cólagena I polimerizada: estudio radiológico, histológico e histoquímico.  Rev Mex Ortop Traum. 1996;  10 142-152
• 2 Krötzsch-Gomez F E, Furuzawa-Carballeda J, Reyes-Marquez R. et al . Cytokine expression is downregulated by collagen-polyvinylpyrrolidone in hypertrophic scars.  J Invest Dermatol. 1998;  111 828-834