Abstract

Citation: Barawi M, Rehana RW. Novel hemostatic gel used in bleeding esophageal ulcer to promote mucosal healing. J Gastroenterol Res Pract. 2024; 4(3): 1188.

Description

Intraprocedural bleeding during endoscopic intervention, gastrointestinal bleeding, or bleeding tumors can be treated with many different modalities such as heat therapy, endoclipping, or embolization. One alternative option that has been proven in literature to be safe and effective is PuraStat, which is a novel self-assembling peptide used for hemostasis during endoscopic procedures such as polypectomies, submucosal dissection, and mucosal resection. This matrix-forming gel can be easily and safely applied to prevent delayed bleeding, accomplish hemostasis and effectively promote mucosal healing. Our case represents a patient who presented with active upper gastrointestinal bleeding that achieved hemostasis and wound healing with the use of PuraStat.

We present an 86-year-old woman with no significant past medical history who presented with complaints of hematemesis. Vitals were stable and hemoglobin was 11.5 gm/dL. The patient was placed on high dose proton pump inhibitor therapy twice daily. The patient was taken for an EGD by the gastroenterology team within 24 hours of presentation. This revealed a proximal 4 cm linear esophageal ulceration with a large adherent clot (Figure 1A). The clot was carefully removed using a cold snare and was cleared past the gastroesophageal junction. After re-examination, the area was noted to have active oozing (Figure 1B).

The bleed was treated with PuraStat, a novel self-assembling peptide in gel form. It was applied by injection topically over the ulceration covering it entirely (Figure 1C). The technique using the 25 g needle allows for accuracy and precision during application of the PuraStat, allowing a thin layer to cover the esophageal ulcer. Inspection of ulceration shortly after the PuraStat application showed good hemostasis. Repeat endoscopy performed 2 days later showed a clean based linear ulceration without active oozing or bleeding (Figure 1D).

Our case represents a patient who presented with an active upper gastrointestinal bleed which achieved hemostasis and wound healing with the use of PuraStat. This case demonstrated that the matrix forming gel can be easily and safely applied with precision while using a 25 g needle tip to prevent delayed bleeding, accomplish hemostasis, and promote wound healing.

Declarations

Funding: This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest: The authors have no conflict of interestto declare.