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Endoscopic Hemostasis With PuraStat for Colonic Diverticular Bleeding
TAKE-HOME MESSAGE
- This multicenter retrospective pilot study evaluated the efficacy and safety of endoscopic hemostasis using PuraStat, an absorbent localized hemostatic agent, in patients with colonic diverticular bleeding (CDB). Overall, 25 patients who had CDB with stigmata of recent hemorrhage were treated with PuraStat monotherapy or combination therapy comprising PuraStat with endoscopic band ligation or clipping (group A). Treatment outcomes and adverse events were compared with those of a previous cohort of patients with CDB who underwent endoscopic hemostasis without PuraStat (group B). The success rates were comparable between groups A and B (100% vs 96.4%; P = 1.000); however, the rebleeding rate within 30 days was significantly lower in group A.
- This study suggests that adding PuraStat to endoscopic band ligation or clipping was associated with a reduced risk of rebleeding in patients with CDB with stigmata of recent hemorrhage.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND AND AIMS
PuraStat (3-D Matrix, Tokyo, Japan) is an absorbent localized hemostatic agent that utilizes self-assembling peptide technology. In this multicenter pilot study, we evaluated the efficacy and safety of endoscopic hemostasis using PuraStat in patients with colonic diverticular bleeding (CDB).
METHODS
This study involved patients who had CDB with stigmata of recent hemorrhage (SRH) and underwent endoscopic hemostasis with PuraStat monotherapy or combination therapy comprising PuraStat with endoscopic band ligation (EBL) or clipping (Group A). Treatment outcomes and adverse events were assessed and compared with those of a previous cohort who underwent endoscopic hemostasis without PuraStat for CDB with SRH (Group B). Factors associated with the reduction of rebleeding were subsequently investigated.
RESULTS
PuraStat was used in 25 patients with CDB. Their mean age was 70.8 years, 13 (52.0%) were male, and the most frequent bleeding sites were in the ascending colon [15 (60.0%) patients]. The success rate of endoscopic hemostasis was 100% (25/25); 2 patients were treated with PuraStat monotherapy and 23 with combination therapy (EBL, 13 patients; clipping, 10 patients). The success rates were comparable between Groups A and B (100% vs. 96.4%, P=1.000). The rate of rebleeding within 30 days was significantly lower in Group A than B (4.0% vs. 20.9%, P=0.047). Multivariate analyses revealed that the addition of Purastat was associated with the reduced risk of rebleeding (odds ratio 0.11, 95% confidence interval 0.01-0.95; P=0.045).
CONCLUSIONS
PuraStat can be easily added to the conventional hemostatic methods for CDB, that could lower the risk of rebleeding.
Additional Info
Disclosure statements are available on the authors' profiles:
Efficacy and safety of endoscopic hemostasis with a self-assembling peptide solution in patients with colonic diverticular bleeding: A multicenter pilot study
Gastrointest. Endosc. 2024 Nov 07;[EPub Ahead of Print], D Yamaguchi, N Tominaga, G Mori, T Yasuda, T Yukimoto, Y Minoda, K Miyahara, K Ohtsu, Y Ito, K Yamanouchi, K Gondo, T Nomura, Y Tanaka, M Tomonaga, M Esaki, T Shimamura, Y Takeuchi, M EsakiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
PuraStat has recently emerged as an effective and popular hemostatic agent for a wide breadth of entities that cause gastrointestinal bleeding. Its unique molecular properties and hydrogel formation mechanism have brought it success, particularly in scenarios where conventional endoscopic options are not as effective. In our unit and many others, PuraStat is a favored choice when the source of bleeding is a large oozing tumor.
This article by Yamaguchi et al is a multicenter retrospective pilot study examining the efficacy of PuraStat for yet another cause of bleeding — colonic diverticular bleeds.
In a 13-month period ending in 2023, this study has 74 patients scoped for suspected colonic diverticular bleeding. Of these, 25 patients were determined to have definite diverticular bleeds and were treated with PuraStat alone or PuraStat with band ligation or clipping. In comparison with a historical control group of 110 patients with diverticular bleeding managed by traditional interventions (band ligation, clipping, or coagulation) with otherwise comparable patient characteristics and hemostasis success rates, the authors demonstrated their group of 25 patients receiving PuraStat to have a statistically significant lower rate of 30-day rebleeding (4.0% vs 20.9%).
As a pilot study, the subject group is small; however, the finding that PuraStat may reduce rebleeding is exciting. Colonic diverticular bleeds can be difficult to endoscopically manage, and radiologic or surgical intervention is often required for refractory bleeds. This study undoubtedly generates interest in PuraStat as a tool for diverticular bleeds and any potential larger-powered studies in the future. Of course, PuraStat may not solve what many of us find to be the most perplexing problem when encountering a diverticular bleed — finding the offending tic!