Published online Mar 16, 2024. doi: 10.4253/wjge.v16.i3.168
Peer-review started: December 19, 2023
First decision: January 4, 2024
Revised: January 9, 2024
Accepted: January 31, 2024
Article in press: January 31, 2024
Published online: March 16, 2024
Endoscopic mucosal dissection has become the standard treatment for early gastric cancer. However, post-endoscopic submucosal dissection (ESD) ulcer occurs in 4.4% of patients. This study hypothesized whether applying PuraStat, a novel hemostatic peptide solution, prevents post-ESD bleeding.
To investigate the preventive potential of PuraStat, a hemostatic formulation, against bleeding in post-ESD gastric ulcers.
Between May 2022 and March 2023, 101 patients (Group P) underwent ESD for gastric diseases at our hospital and received PuraStat (2 mL) for post-ESD ulcers. We retrospectively compared this group with a control group (Group C) com
Post-ESD bleeding occurred in 6 (5.9%) (95%CI: 2.8–12.4) and 20 (6.7%) (95%CI: 4.4–10.2) patients in Groups P and C, respectively, with no significant between-group difference. The relative risk was 1.01 (95%CI: 0.95–1.07). The lesser curvature or anterior wall was the bleeding site in all 6 patients who experienced postoperative bleeding in Group P. In multivariate analysis, the odds ratios for resection diameter ≥ 50 mm and oral anticoagulant use were 6.63 (95%CI: 2.52–14.47; P = 0.0001) and 4.04 (1.26–0.69; P = 0.0164), respectively. The adjusted odds ratio of post-ESD bleeding and PuraStat was 1.28 (95%CI: 0.28–2.15).
PuraStat application is not associated with post-ESD bleeding. However, the study suggests that gravitational forces may affect the effectiveness of applied PuraStat.
Core Tip: In this investigation, we assessed the potential of PuraStat®, a hemostatic formulation, to prevent bleeding in post-endoscopic submucosal dissection (ESD) gastric ulcers. Application of PuraStat (2 mL) to the post-ESD ulcer in 101 patients who underwent ESD for gastric diseases at our hospital did not exhibit an association with post-ESD bleeding. However, our observations suggest that gravitational forces may affect the efficacy of applied PuraStat. Therefore, we aim to develop strategies to mitigate the risk of PuraStat flowing away from the targeted area of interest in further investigations.