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 (ESD) has become the standard of care for early gastric cancer, but bleeding from ulcers after ESD occurs in 4.4% of patients. We aim to minimize post-ESD bleeding to the greatest extent possible. PuraStat (3D-Matrix Europe Ltd., France) is a novel hemostatic peptide solution aiming to reduce the need for cautery with hemostatic forceps in treating exudative bleeding during gastrointestinal endoscopy. We hypothesized that applying PuraStat to gastric ulcers after ESD could prevent post-ESD bleeding.
Reducing post-ESD bleeding is a crucial goal. If PuraStat can be applied to post-ESD gastric ulcers to prevent post-ESD bleeding, it may have broader applications in gastrointestinal bleeding.
The purpose of this study is to determine whether the application of PuraStat to gastric ulcers after ESD can prevent post-ESD bleeding.
From May 2022 to March 2023, 101 patients (Group P) who underwent ESD for gastric diseases at our hospital received PuraStat (2 mL) applied to their post-ESD ulcer. 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). Therefore, PuraStat application was not associated with post-ESD bleeding. The lesser curvature or anterior wall was the bleeding site in all 5 patients who experienced postoperative bleeding in the PuraStat group. This suggests that gravitational forces may affect the efficacy of applied PuraStat. Specifically, PuraStat seemed less effective for lesions on the anterior wall and lesser curvature than those on the greater curvature and posterior wall. Adjusting the patient’s position during its application could potentially enhance PuraStat’s effectiveness by preventing the hemostatic material from flowing away from the targeted area.
PuraStat application is not associated with post-ESD bleeding.
We infer that gravitational forces may affect the efficacy of applied PuraStat. Hence, we aim to explore and develop strategies to prevent PuraStat from flowing away from the targeted areas of interest in further investigation.