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Maruoka R, Esaki M, Minoda Y, Otsuka Y, Haraguchi K, Ogino H, Ihara E. Effective hemostasis with a self-assembling peptide hemostatic gel to manage leaky hemorrhage at the ulcer closure site after gastric endoscopic submucosal dissection. Endoscopy 2024; 56:E323-E324. [PMID: 38594001 PMCID: PMC11003806 DOI: 10.1055/a-2291-9050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Ryohei Maruoka
- Department of Gastroenterology, Harasanshin Hospital, Harasanshin Hospital, Fukuoka, Japan
| | - Mitsuru Esaki
- Department of Gastroenterology, Harasanshin Hospital, Harasanshin Hospital, Fukuoka, Japan
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Otsuka
- Department of Gastroenterology, Harasanshin Hospital, Harasanshin Hospital, Fukuoka, Japan
| | - Kazuhiro Haraguchi
- Department of Gastroenterology, Harasanshin Hospital, Harasanshin Hospital, Fukuoka, Japan
| | - Haruei Ogino
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Voiosu A, State M, Drăgan V, Văduva S, Bălănescu P, Mateescu RB, Voiosu T. Systematic review of self-assembling peptides as topical agents for treatment and prevention of gastrointestinal bleeding. Clin Endosc 2024; 57:454-465. [PMID: 38919060 PMCID: PMC11294863 DOI: 10.5946/ce.2023.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND/AIMS Gastrointestinal bleeding is a significant and potentially lethal event. We aimed to review the efficiency and safety of self-assembling peptides for the treatment and prevention of gastrointestinal tract bleeding. METHODS We conducted a systematic search for studies describing the endoscopic use of self-assembling peptides for treatment or prevention of bleeding in the gastrointestinal tract in a parallel, independent fashion. The primary outcomes were rates of successful initial hemostasis, delayed bleeding, and rebleeding. The secondary outcomes were adverse events and ease and volume of gel used. RESULTS Seventeen studies were analyzed. Overall success rate of self-assembling peptides in gastrointestinal bleeding was 87.7% (38%-100%), regardless of etiology or associated treatments. Rebleeding rate ranged from 0% to 16.2%, with a mean of 4.7%, and overall delayed bleeding rate was 5% (range, 0%-15.9%). Only three adverse events were reported in a pooled number of 815 patients. The volume of gel used varied (0.43 to 3.7 mL) according to indication and type of bleeding. CONCLUSIONS The limited available data on the use of self-assembling peptides in gastrointestinal endoscopy suggest a high efficiency and good safety profile.
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Affiliation(s)
- Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica State
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Victor Drăgan
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sergiu Văduva
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Paul Bălănescu
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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3
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Ishikawa Y, Goto O, Nakagome S, Habu T, Kirita K, Koizumi E, Higuchi K, Noda H, Onda T, Omori J, Akimoto N, Iwakiri K. Spray coagulation reduces the use of hemostatic forceps for intraoperative bleeding in gastric endoscopic submucosal dissection. JGH Open 2024; 8:e70002. [PMID: 39036415 PMCID: PMC11258569 DOI: 10.1002/jgh3.70002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024]
Abstract
Aims During intraoperative bleeding in endoscopic submucosal dissection (ESD), switching to spray coagulation may be beneficial compared with the continuous use of swift coagulation and can reduce the need for hemostatic forceps. We retrospectively assessed the effectiveness of spray modes on intraoperative bleeding during gastric ESD. Methods and Results A total of 316 bleeding events (156 in the Swift group and 160 in the Spray group) were consecutively recorded. In the Swift group, hemostasis was performed using the swift mode with a retracted tip of the needle-type knife, followed by the hemostatic forceps. In the Spray group, bleeding was treated in a stepwise manner: the swift mode, the spray mode, and the hemostatic forceps. All bleeding events were assigned to one of two groups by an endoscopist who retrospectively reviewed the videos. We compared the use of hemostatic forceps, the total hemostatic time, and the cumulative hemostasis rate between the two groups.The use of hemostatic forceps was significantly lower in the Spray group than in the Swift group (32.7% vs. 13.8%, P < 0.001). There was no significant difference in the total hemostatic time (Swift group, 20 s.; Spray group, 16 s.; P = 0.42), whereas the cumulative hemostasis rate with the knife was significantly higher in the Spray group (P = 0.007). Conclusion The results suggested that spray coagulation from the tip of the needle-type knife could reduce the use of hemostatic forceps. In gastric ESD, spray coagulation may facilitate the hemostasis of intraoperative bleeding.
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Affiliation(s)
- Yumiko Ishikawa
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Osamu Goto
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
- Endoscopy CenterNippon Medical School HospitalTokyoJapan
| | - Shun Nakagome
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Tsugumi Habu
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Kumiko Kirita
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Eriko Koizumi
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Kazutoshi Higuchi
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Hiroto Noda
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Takeshi Onda
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Jun Omori
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Naohiko Akimoto
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Katsuhiko Iwakiri
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
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Sugawara N, Hakoda A, Iwatsubo T, Sasaki S, Tanaka H, Ota K, Nishikawa H. The "Dumpling method:" Novel technique for preventing PuraStat migration and enhancing hemostasis. Endosc Int Open 2024; 12:E769-E771. [PMID: 38904058 PMCID: PMC11189674 DOI: 10.1055/a-2317-0664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/25/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Noriaki Sugawara
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Akitoshi Hakoda
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Taro Iwatsubo
- Endoscopy Center of Gastroenterology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shun Sasaki
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hironori Tanaka
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kazuhiro Ota
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Yamaguchi D, Tanaka Y, Nomura T. Over-the-scope clip rescue method of endoscopic hemostasis for severe acute colonic diverticular bleeding. Dig Endosc 2024; 36:506-507. [PMID: 38353173 DOI: 10.1111/den.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/16/2024] [Indexed: 04/13/2024]
Abstract
Watch a video of this article.
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Affiliation(s)
- Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Saga, Japan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuichiro Tanaka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Tadahiro Nomura
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Saga, Japan
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Wehbe H, Gutta A, Gromski MA. Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon. Gastrointest Endosc Clin N Am 2024; 34:363-381. [PMID: 38395489 DOI: 10.1016/j.giec.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Post-polypectomy bleeding (PPB) remains a significant procedure-related complication, with multiple risk factors determining the risk including patient demographics, polyp characteristics, endoscopist expertise, and techniques of polypectomy. Immediate PPB is usually treated promptly, but management of delayed PPB can be challenging. Cold snare polypectomy is the optimal technique for small sessile polyps with hot snare polypectomy for pedunculated and large sessile polyps. Topical hemostatic powders and gels are being investigated for the prevention and management of PPB. Further studies are needed to compare these topical agents with conventional therapy.
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Affiliation(s)
- Hisham Wehbe
- Department of Internal Medicine, Indiana University School of Medicine, 550 University Boulevard, UH 3533, Indianapolis, IN 46202, USA
| | - Aditya Gutta
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100 Indianapolis, IN 46202, USA
| | - Mark A Gromski
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100 Indianapolis, IN 46202, USA.
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Gomi K, Yamamoto Y, Yoshida E, Tohata M, Nagahama M. Using a novel hemostatic peptide solution to prevent bleeding after endoscopic submucosal dissection of a gastric tumor. World J Gastrointest Endosc 2024; 16:168-174. [PMID: 38577651 PMCID: PMC10989251 DOI: 10.4253/wjge.v16.i3.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/09/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND 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.
AIM To investigate the preventive potential of PuraStat, a hemostatic formulation, against bleeding in post-ESD gastric ulcers.
METHODS 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) comprising 297 patients who underwent ESD for gastric diseases at our hospital between April 2017 and March 2021. P values < 0.05 on two-sided tests indicated significance.
RESULTS 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).
CONCLUSION PuraStat application is not associated with post-ESD bleeding. However, the study suggests that gravitational forces may affect the effectiveness of applied PuraStat.
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Affiliation(s)
- Kuniyo Gomi
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Yorimasa Yamamoto
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Erika Yoshida
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Misako Tohata
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Masatsugu Nagahama
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
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Ogura T, Uba Y, Yamamura M, Nishioka N, Nishikawa H. Endoscopic hemostasis using self-expandable metal stent combined with PuraStat Ⓡ for patient with high risk of post-endoscopic sphincterotomy bleeding (with video). Hepatobiliary Pancreat Dis Int 2024; 23:94-96. [PMID: 36754705 DOI: 10.1016/j.hbpd.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
| | - Yuki Uba
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masahiro Yamamura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Yoshida N, Dohi O, Inagaki Y, Tomita Y, Hashimoto H, Kobayashi R, Inoue K, Hirose R, Morimoto Y, Inada Y, Murakami T, Itoh Y. Efficacy of hemostatic gel for perioperative bleeding and prevention of delayed bleeding of cold snare polypectomy under anticoagulant. JGH Open 2024; 8:e13029. [PMID: 38268964 PMCID: PMC10805485 DOI: 10.1002/jgh3.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
Background and Aim A hemostatic gel, PuraStat (3-D Matrix, Tokyo, Japan), is used for various gastrointestinal hemostasis. In this study, we analyzed the efficacy of PuraStat for perioperative bleeding (POB) and prevention of delayed bleeding (DB) to colorectal cold snare polypectomy (CSP) with continuous anticoagulant. Methods This was a single-center, retrospective study. Subjects were lesions of 2-9 mm under continuous anticoagulant from 2021 to 2023 and treated with PuraStat for POB. The definition of POB was bleeding which did not stop spontaneously by 1.0-1.5 min after resection and needed hemostasis. Successful hemostasis was defined as cessation of bleeding within 1.0-1.5 min after spraying PuraStat and the rate of it and risk factors of POB were analyzed. For comparison, cases receiving previous CSP without PuraStat were extracted from all cases with CSP (2018-2021), and POB and DB rate (DBR) were analyzed after propensity score matching. Results One hundred twenty-two lesions (91: direct oral anticoagulant (DOAC), 31: warfarin) with anticoagulant were analyzed and the rate of successful hemostasis with PuraStat was 92.6% (DOAC/warfarin: 93.4%/80.6%, P = 0.01). The rate of DB was 0.0%. Multivariate analysis showed that significant risk factors about unsuccessful hemostasis for POB with PuraStat were lesion size 8-9 mm (P < 0.01), warfarin (P = 0.01), and combination of antiplatelet (P = 0.01). Regarding the comparison about CSP with/without PuraStat, the clipping rate and DBR were 8.5%/94.9% (P < 0.01) and 0%/1.7% (P = 1.0). Conclusion The effects of PuraStat for POB and DB in colorectal CSP with continuous anticoagulant were acceptable.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | | | - Yuri Tomita
- Department of GastroenterologyKoseikai Takeda HospitalKyotoJapan
| | - Hikaru Hashimoto
- Department of GastroenterologyOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | | | - Yutaka Inada
- Department of GastroenterologyKyoto First Red Cross HospitalKyotoJapan
| | - Takaaki Murakami
- Department of GastroenterologyAiseikai Yamashina HospitalKyotoJapan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
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Inoue T, Ibusuki M, Kitano R, Kobayashi Y, Ito K, Yoneda M. Successful hemostasis and subsequent cannulation using a self-assembling peptide hydrogel for bleeding after precut sphincterotomy. Endoscopy 2023; 55:E759-E760. [PMID: 37236256 PMCID: PMC10219753 DOI: 10.1055/a-2085-0838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Mayu Ibusuki
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Rena Kitano
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Yuji Kobayashi
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Kiyoaki Ito
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Masashi Yoneda
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
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11
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Inoue T, Ibusuki M, Kitano R, Kobayashi Y, Ito K, Yoneda M. Successful hemostasis using a self-assembling peptide hydrogel for bleeding after endoscopic papillary large-balloon dilation. Endoscopy 2023; 55:E555-E556. [PMID: 36931307 PMCID: PMC10023252 DOI: 10.1055/a-2037-5913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Mayu Ibusuki
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Rena Kitano
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Yuji Kobayashi
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Kiyoaki Ito
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Masashi Yoneda
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
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Doyle JB, Visrodia K. Closing the Gap in Prophylactic Treatment of Duodenal Endoscopic Submucosal Dissection Defects. GASTRO HEP ADVANCES 2023; 2:1136-1137. [PMID: 39131549 PMCID: PMC11308722 DOI: 10.1016/j.gastha.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 08/13/2024]
Affiliation(s)
- John B. Doyle
- Digestive and Liver Diseases, Columbia University Irving Medical Center-NYP, New York, New York
| | - Kavel Visrodia
- Digestive and Liver Diseases, Columbia University Irving Medical Center-NYP, New York, New York
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Dhindsa BS, Tun KM, Scholten KJ, Deliwala S, Naga Y, Dhaliwal A, Ramai D, Saghir SM, Dahiya DS, Chandan S, Singh S, Adler DG. New Alternative? Self-Assembling Peptide in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:3694-3701. [PMID: 37402986 DOI: 10.1007/s10620-023-08009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is a common and potentially fatal condition with all-cause mortality ranging from 3 to 10%. Endoscopic therapy traditionally involves mechanical, thermal, and injection therapies. Recently, self-assembling peptide (SAP) has become increasingly available in the United States. When applied to an affected area, this gel forms an extracellular matrix-type structure allowing for hemostasis. This is the first systematic review and meta-analysis to assess the safety and efficacy of this modality in GIB. METHODS We performed a comprehensive literature search of major databases from inception to Nov 2022. The primary outcomes assessed were the success of hemostasis, rebleeding rates, and adverse events. The secondary outcomes assessed were successful hemostasis with monotherapy with SAP and combined therapy, which may include mechanical, injection, and thermal therapies. Pooled estimates were calculated using random-effects models with a 95% confidence interval (CI). RESULTS The analysis included 7 studies with 427 patients. 34% of the patients were on anticoagulation or antiplatelet agents. SAP application was technically successful in all patients. The calculated pooled rate of successful hemostasis was 93.1% (95% confidence interval (CI) 84.7-97.0, I2 = 73.6), and rebleeding rates were 8.9% (95% CI 5.3-14.4, I2 = 55.8). The pooled rates of hemostasis with SAP monotherapy and combined therapy were similar. No adverse events were noted related to SAP. CONCLUSION SAP appears to be a safe and effective treatment modality for patients with GIB. This modality provides an added advantage of improved visualization over the novel spray-based modalities. Further, prospective, or randomized controlled trials are needed to validate our findings.
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Affiliation(s)
- Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Las Vegas, NV, 89102, USA
| | - Kyle J Scholten
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Smit Deliwala
- Division of Gastroenterology and Hepatology, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Yassin Naga
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, McLeod Regional Medical Center, Florence, SC, 29506, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, Room 4R118, Salt Lake City, UT, 84132, USA
| | - Syed Mohsin Saghir
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Dushyant Singh Dahiya
- Division of Internal Medicine, Central Michigan University, 1015 S Washington Ave, Saginaw, MI, 48603, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Professor of Medicine, Centura Health, Denver, CO, USA.
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Yang Z, Chen L, Liu J, Zhuang H, Lin W, Li C, Zhao X. Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2301849. [PMID: 36942893 DOI: 10.1002/adma.202301849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Short designer self-assembling peptide (dSAP) biomaterials are a new addition to the hemostat group. It may provide a diverse and robust toolbox for surgeons to integrate wound microenvironment with much safer and stronger hemostatic capacity than conventional materials and hemostatic agents. Especially in noncompressible torso hemorrhage (NCTH), diffuse mucosal surface bleeding, and internal medical bleeding (IMB), with respect to the optimal hemostatic formulation, dSAP biomaterials are the ingenious nanofiber alternatives to make bioactive neural scaffold, nasal packing, large mucosal surface coverage in gastrointestinal surgery (esophagus, gastric lesion, duodenum, and lower digestive tract), epicardiac cell-delivery carrier, transparent matrix barrier, and so on. Herein, in multiple surgical specialties, dSAP-biomaterial-based nano-hemostats achieve safe, effective, and immediate hemostasis, facile wound healing, and potentially reduce the risks in delayed bleeding, rebleeding, post-operative bleeding, or related complications. The biosafety in vivo, bleeding indications, tissue-sealing quality, surgical feasibility, and local usability are addressed comprehensively and sequentially and pursued to develop useful surgical techniques with better hemostatic performance. Here, the state of the art and all-round advancements of nano-hemostatic approaches in surgery are provided. Relevant critical insights will inspire exciting investigations on peptide nanotechnology, next-generation biomaterials, and better promising prospects in clinics.
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Affiliation(s)
- Zehong Yang
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
- Institute for Nanobiomedical Technology and Membrane Biology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Lihong Chen
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ji Liu
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hua Zhuang
- Department of Ultrasonography, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, Sichuan, 610041, China
| | - Wei Lin
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Women and Children Diseases of the Ministry of Education, Sichuan University, No. 17 People's South Road, Chengdu, Sichuan, 610041, China
| | - Changlong Li
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaojun Zhao
- Institute for Nanobiomedical Technology and Membrane Biology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
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15
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Nakahara K, Michikawa Y, Sato J, Igarashi Y, Sekine A, Satta Y, Tateishi K. A novel self-assembling peptide hemostatic gel as rescue therapy for fistula bleeding after endoscopic ultrasound-guided hepaticogastrostomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:e66-e67. [PMID: 36866588 DOI: 10.1002/jhbp.1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
The novel synthetic self-assembling peptide PuraStat has been approved for hemostasis in endoscopic procedures. Nakahara and colleagues describe their application of PuraStat for hemostasis of refractory fistula bleeding after endoscopic ultrasound-guided hepaticogastrostomy. The effective and technically easy procedure is a useful option when hemostasis cannot be achieved by other means.
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Affiliation(s)
- Kazunari Nakahara
- Department of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yosuke Michikawa
- Department of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junya Sato
- Department of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yosuke Igarashi
- Department of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Akihiro Sekine
- Department of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yusuke Satta
- Department of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keisuke Tateishi
- Department of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan
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16
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Kim GE, Siddiqui UD. Endoscopic Resection Techniques for Duodenal and Ampullary Adenomas. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:330-335. [PMID: 37575136 PMCID: PMC10422085 DOI: 10.1016/j.vgie.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background and Aims Duodenal polyps have a reported incidence of 0.3% to 4.6%. Sporadic, nonampullary duodenal adenomas (SNDAs) comprise less than 10% of all duodenal polyps, and ampullary adenomas are even less common. Nonetheless, the incidence continues to rise because of widespread endoscopy use. Duodenal polyps with villous features or those that are larger than 10 mm may raise concern for malignancy and require removal. We demonstrate endoscopic resection of SNDAs and ampullary adenomas using some of our preferred techniques. Methods The duodenum has several components that can make EMR of duodenal polyps technically challenging. Not only does the duodenum have a thin muscle layer, but it is also highly mobile and vascular, which may explain higher rates of perforation and bleeding of duodenal EMR reported in the literature compared with colon EMR. A standard adult gastroscope with a distal cap is commonly used for duodenal EMRs. Based on the location, however, side-viewing duodenoscopes or pediatric colonoscopes may be used. To prepare for EMR, a submucosal injection is performed for an adequate lift. The polyp is then resected via stiff monofilament snares and subsequently closed with hemostatic clips if feasible. The ampullectomy technique differs slightly from duodenal EMRs and carries the additional risk of pancreatitis. Submucosal injection in the ampulla may not lift well; thus, its utility is debatable. Biliary sphincterotomy should be performed, and based on endoscopist preference, the pancreatic duct (PD) guidewire can be left during resection to maintain access. After resection, a PD stent is placed to minimize pancreatitis risk. Results The video shows the aforementioned duodenal EMR techniques. Two clips of ampullectomy are also shown in the video. Conclusions A few common techniques used to perform duodenal EMR and ampullectomy are highlighted in the video. It is important to understand and manage adverse events associated with these procedures and to have established surveillance plans.
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Affiliation(s)
- Grace E Kim
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, University of Chicago, Chicago, Illinois
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics, University of Chicago, Chicago, Illinois
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17
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Kano Y, Sunakawa H, Nakajo K, Kadota T, Yano T. Efficacy of a novel self-assembling peptide gel for hemostasis in refractory neoplastic bleeding. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:307-309. [PMID: 37575138 PMCID: PMC10422049 DOI: 10.1016/j.vgie.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Video 1Outline of how self-assembling peptide gel can be used ex vivo.
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Affiliation(s)
- Yuki Kano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hironori Sunakawa
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Murakami T, Kamba E, Haga K, Akazawa Y, Ueyama H, Shibuya T, Hojo M, Nagahara A. Emergency Endoscopic Hemostasis for Gastrointestinal Bleeding Using a Self-Assembling Peptide: A Case Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050931. [PMID: 37241163 DOI: 10.3390/medicina59050931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: A novel synthetic self-assembling peptide, PuraStat, has been introduced as a hemostatic agent. This case series aimed to evaluate the clinical efficacy of PuraStat for gastrointestinal bleeding during emergency endoscopy. Cases: Twenty-five patients with gastrointestinal bleeding who had undergone emergency endoscopy with PuraStat between August 2021 and December 2022 were retrospectively examined. Six patients were receiving antithrombotic agents, and ten patients with refractory gastrointestinal bleeding had undergone at least one endoscopic hemostatic procedure. The breakdown of bleeding was gastroduodenal ulcer/erosion in 12 cases, bleeding after gastroduodenal or colorectal endoscopic resection in 4 cases, rectal ulcer in 2 cases, postoperative anastomotic ulcer in 2 cases, and gastric cancer, diffuse antral vascular ectasia, small intestinal ulcer, colonic diverticular bleeding, and radiation proctitis in each case. The method of hemostasis was only PuraStat application in six cases, and hemostasis in combination with high-frequency hemostatic forceps, hemostatic clip, argon plasma coagulation, and hemostatic agents (i.e., thrombin) in the remaining cases. Rebleeding was observed in three cases. Hemostatic efficiency was observed in 23 cases (92%). Conclusions: PuraStat has the expected hemostatic effect on gastrointestinal bleeding during emergency endoscopy. The use of PuraStat should be considered in emergency endoscopic hemostasis of gastrointestinal bleeding.
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Affiliation(s)
- Takashi Murakami
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Eiji Kamba
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
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19
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Gopakumar H, Vohra I, Sharma NR, Puli SR. Efficacy of self-assembling peptide in mitigating delayed bleeding after advanced endoscopic resection of gastrointestinal lesions: A meta-analysis. Endosc Int Open 2023; 11:E553-E560. [PMID: 37251794 PMCID: PMC10219783 DOI: 10.1055/a-2057-4505] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/22/2023] [Indexed: 05/31/2023] Open
Abstract
Background and study aims Advanced endoscopic resection techniques carry a risk of delayed bleeding (DB). A novel fully synthetic self-assembling peptide (SAP) has shown promising results in mitigating this risk. In this meta-analysis, we evaluated all available data and analyzed the effectiveness of SAP in reducing DB after advanced endoscopic resection of gastrointestinal luminal lesions. Patients and methods Electronic databases (PubMed, Embase, and Cochrane Library) from January 2010 through October 2022 were searched for publications addressing the use of SAP solution in patients undergoing advanced endoscopic resection of gastrointestinal lesions. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models. Results The initial search identified 277 studies, of which 63 relevant articles were reviewed. The final analysis included data from six studies comprising 307 patients that met inclusion criteria. The pooled rate of DB was 5.73 % (95 % confidence interval [CI] = 3.42-8.59). Mean patient age was 69.40 years ± 1.82. The weighted mean size of resected lesions was 36.20 mm (95 % CI = 33.37-39.02). Endoscopic submucosal dissection was used in 72.69 % (95 % CI = 67.62-77.48), while endoscopic mucosal resection was used in 26.42 % (95 % CI = 21.69-31.44) of the procedures. Among the 307 patients, 36 % were on antithrombotic medications. No adverse events (AEs) were attributable to using SAP, with a pooled rate of 0.00 % (95 % CI = 0.00-1.49). Conclusions SAP solution appears promising in reducing post-procedural DB after advanced endoscopic resection of high-risk gastrointestinal lesions with no reported AEs.
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Affiliation(s)
- Harishankar Gopakumar
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
| | - Ishaan Vohra
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
| | - Neil R. Sharma
- Parkview Cancer Institute, Interventional Oncology & Surgical Endoscopy (IOSE) division, GI Oncology Tumor Site Team, Fort Wayne, Indiana, United States
| | - Srinivas R. Puli
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
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20
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Binda C, Fugazza A, Fabbri S, Coluccio C, Repici A, Tarantino I, Anderloni A, Fabbri C. The Use of PuraStat ® in the Management of Walled-Off Pancreatic Necrosis Drained Using Lumen-Apposing Metal Stents: A Case Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040750. [PMID: 37109708 PMCID: PMC10144217 DOI: 10.3390/medicina59040750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Bleeding is one of the most feared and frequent adverse events in the case of EUS-guided drainage of WOPN using lumen-apposing metal stents (LAMSs) and of direct endoscopic necrosectomy (DEN). When it occurs, its management is still controversial. In the last few years, PuraStat, a novel hemostatic peptide gel has been introduced, expanding the toolbox of the endoscopic hemostatic agents. The aim of this case series was to evaluate the safety and efficacy of PuraStat in preventing and controlling bleeding of WOPN drainage using LAMSs. Materials and Methods: This is a multicenter, retrospective pilot study from three high-volume centers in Italy, including all consecutive patients treated with the novel hemostatic peptide gel after LAMSs placement for the drainage of symptomatic WOPN between 2019 and 2022. Results: A total of 10 patients were included. All patients underwent at least one session of DEN. Technical success of PuraStat was achieved in 100% of patients. In seven cases PuraStat was placed for post-DEN bleeding prevention, with one patient experiencing bleeding after DEN. In three cases, on the other hand, PuraStat was placed to manage active bleeding: two cases of oozing were successfully controlled with gel application, and a massive spurting from a retroperitoneal vessel required subsequent angiography. No re-bleeding occurred. No PuraStat-related adverse events were reported. Conclusions: This novel peptide gel could represent a promising hemostatic device, both in preventing and managing active bleeding after EUS-guided drainage of WON. Further prospective studies are needed to confirm its efficacy.
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Affiliation(s)
- Cecilia Binda
- AUSL Romagna, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Forlì-Cesena, Italy
| | - Alessandro Fugazza
- Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, 20089 Milan, Italy
| | - Stefano Fabbri
- AUSL Romagna, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Forlì-Cesena, Italy
| | - Chiara Coluccio
- AUSL Romagna, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Forlì-Cesena, Italy
| | - Alessandro Repici
- Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, 20089 Milan, Italy
- Humanitas University, Department of Biomedical Sciences, 20090 Pieve Emanuele, Italy
| | - Ilaria Tarantino
- Digestive Endoscopy and Gastroenterology Unit, Department of Gastroenterology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IsMeTT/UPMC), 90127 Palermo, Italy
| | - Andrea Anderloni
- Fondazione I.R.C.C.S. Policlinico San Matteo, Gastroenterology and Digestive Endoscopy Unit, 27100 Pavia, Italy
| | - Carlo Fabbri
- AUSL Romagna, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Forlì-Cesena, Italy
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21
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Libânio D, Pimentel-Nunes P, Bastiaansen B, Bisschops R, Bourke MJ, Deprez PH, Esposito G, Lemmers A, Leclercq P, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, Fuccio L, Bhandari P, Dinis-Ribeiro M. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023; 55:361-389. [PMID: 36882090 DOI: 10.1055/a-2031-0874] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.
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Affiliation(s)
- Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, FMUP, Porto, Portugal.,Gastroenterology, Unilabs, Portugal
| | - Barbara Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia.,Western Clinical School, University of Sydney, Sydney, Australia
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gianluca Esposito
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy. Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.,University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
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22
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Nakahara K, Sekine A, Tateishi K. Self-assembling peptide gel application to achieve endoscopic hemostasis for fistula bleeding after lumen apposing metal stent removal. Dig Endosc 2023; 35:e48-e49. [PMID: 36727242 DOI: 10.1111/den.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Kazunari Nakahara
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Akihiro Sekine
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Keisuke Tateishi
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
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23
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Sedighi M, Shrestha N, Mahmoudi Z, Khademi Z, Ghasempour A, Dehghan H, Talebi SF, Toolabi M, Préat V, Chen B, Guo X, Shahbazi MA. Multifunctional Self-Assembled Peptide Hydrogels for Biomedical Applications. Polymers (Basel) 2023; 15:polym15051160. [PMID: 36904404 PMCID: PMC10007692 DOI: 10.3390/polym15051160] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
Self-assembly is a growth mechanism in nature to apply local interactions forming a minimum energy structure. Currently, self-assembled materials are considered for biomedical applications due to their pleasant features, including scalability, versatility, simplicity, and inexpensiveness. Self-assembled peptides can be applied to design and fabricate different structures, such as micelles, hydrogels, and vesicles, by diverse physical interactions between specific building blocks. Among them, bioactivity, biocompatibility, and biodegradability of peptide hydrogels have introduced them as versatile platforms in biomedical applications, such as drug delivery, tissue engineering, biosensing, and treating different diseases. Moreover, peptides are capable of mimicking the microenvironment of natural tissues and responding to internal and external stimuli for triggered drug release. In the current review, the unique characteristics of peptide hydrogels and recent advances in their design, fabrication, as well as chemical, physical, and biological properties are presented. Additionally, recent developments of these biomaterials are discussed with a particular focus on their biomedical applications in targeted drug delivery and gene delivery, stem cell therapy, cancer therapy and immune regulation, bioimaging, and regenerative medicine.
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Affiliation(s)
- Mahsa Sedighi
- Department of Pharmaceutics and Nanotechnology, School of Pharmacy, Birjand University of Medical Sciences, Birjand 9717853076, Iran
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand 9717853076, Iran
| | - Neha Shrestha
- Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
- Department of Biomedicine and Translational Research, Research Institute for Bioscience and Biotechnology, Kathmandu P.O. Box 7731, Nepal
| | - Zahra Mahmoudi
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan 6517838636, Iran
| | - Zahra Khademi
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Alireza Ghasempour
- Student Research Committee, Birjand University of Medical Sciences, Birjand 9717853076, Iran
| | - Hamideh Dehghan
- Student Research Committee, Birjand University of Medical Sciences, Birjand 9717853076, Iran
| | - Seyedeh Fahimeh Talebi
- Student Research Committee, Birjand University of Medical Sciences, Birjand 9717853076, Iran
| | - Maryam Toolabi
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Véronique Préat
- Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Bozhi Chen
- State Key Laboratory of Organic-Inorganic Composites, Beijing University of Chemical Technology, Beijing 100029, China
- Beijing Laboratory of Biomedical Materials, College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Xindong Guo
- State Key Laboratory of Organic-Inorganic Composites, Beijing University of Chemical Technology, Beijing 100029, China
- Beijing Laboratory of Biomedical Materials, College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
- Correspondence: (X.G.); (M.-A.S.)
| | - Mohammad-Ali Shahbazi
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- W.J. Kolff Institute for Biomedical Engineering and Materials Science, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Correspondence: (X.G.); (M.-A.S.)
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Yamaguchi D, Ishida S, Nomura T, Mizuta Y, Fujimoto S, Tanaka Y, Tsunada S. Endoscopic hemostasis of spurting colonic diverticular bleeding using the combination of self-assembling peptide solution and endoscopic band ligation. Endoscopy 2023; 55:E418-E419. [PMID: 36758630 PMCID: PMC9911289 DOI: 10.1055/a-2008-0599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Satoshi Ishida
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Tadahiro Nomura
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yumi Mizuta
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Shun Fujimoto
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yuichiro Tanaka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Seiji Tsunada
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
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Efficacy and Safety of a Novel Hemostatic Peptide Solution During Endoscopic Submucosal Dissection: A Multicenter Randomized Controlled Trial. Am J Gastroenterol 2023; 118:276-283. [PMID: 36449784 PMCID: PMC9889198 DOI: 10.14309/ajg.0000000000002060] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION To compare the effectiveness of the novel hemostatic peptide, TDM-621, with that of conventional hemostatic methods in treating intraoperative blood oozing during endoscopic submucosal dissection (ESD). METHODS This multicenter, open-label, randomized controlled trial involved 227 patients with gastric and rectal epithelial tumors in whom ESD was indicated. Patients in whom the source of blood oozing was difficult to identify with waterjet washing during the procedure and required hemostasis with hemostatic forceps were randomly assigned to the TDM-621 and control groups. The TDM-621 group (in which hemostasis was achieved with TDM-621, followed by coagulation hemostasis with hemostatic forceps, as needed) was compared with the control group (in which hemostasis was achieved with hemostatic forceps). The primary end point was the mean number of coagulations with hemostatic forceps, determined by a blinded independent review committee. The secondary end points were the rate of achievement of hemostasis with only TDM-621, the dosage of TDM-621, and adverse events in the TDM-621 group. RESULTS The mean number of coagulations with hemostatic forceps was significantly reduced in the TDM-621 group (1.0 ± 1.4) compared with that in the control group (4.9 ± 5.2) ( P < 0.001). The rate of hemostasis achievement with only TDM-621 was 62.2%; the mean dosage of TDM-621 was 1.75 ± 2.14 mL. The rates of grade ≥3 adverse events were 6.2% and 5.0% in the TDM-621 and control groups, respectively. DISCUSSION TDM-621 is a useful, easily operable hemostatic peptide for treatment of blood oozing during gastric and rectal ESD, with no serious safety concerns.
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Lesmana CRA, Sandra S, Paramitha MS, Gani RA, Lesmana LA. Endoscopic Management Using Novel Haemostatic Agents for Immediate Bleeding during Endoscopic Retrograde Cholangio-Pancreatography. Can J Gastroenterol Hepatol 2023; 2023:5212580. [PMID: 37077936 PMCID: PMC10110383 DOI: 10.1155/2023/5212580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/07/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
Bleeding after endoscopic sphincterotomy (ES) remains as a major challenge during ERCP procedure. Standard endoscopic haemostatic procedures have demonstrated good performance for bleeding control. Novel endoscopic haemostatic agents have also been widely used in gastrointestinal bleeding management. Regardless, there is still a paucity of high-quality evidence evaluating the practicality of these agents in ERCP. This case series study was performed on the patients who underwent ERCP procedure in a tertiary referral private hospital within 2 years period. Post-ES immediate bleeding is defined as the onset of bleeding at the time of sphincterotomy. Treatment groups for post-ES bleeding are divided into (1) standard haemostatic methods and (2) novel haemostatic agents. There were 40 patients who received standard haemostatic treatment and 60 patients who received novel haemostatic agents. Initial haemostasis was achieved in all patients. Two patients who received standard haemostatic treatment had rebleeding. Meanwhile, no patients in novel haemostatic treatment group had rebleeding. In conclusion, novel haemostatic agent can be considered as an easy and practical method in daily practice, especially when an ERCP procedure is performed. Further studies with larger sample size which, if possible, can also include a cost-effectiveness analysis are still required to implement these agents as a standard procedure in clinical practice. (This abstract has been presented at the American College of Gastroenterology meeting October 2021).
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Affiliation(s)
- Cosmas Rinaldi Adithya Lesmana
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
- Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia
- Gastrointestinal Cancer Center, MRCCC Siloam Semanggi Hospital, Jakarta, Indonesia
| | - Sharon Sandra
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Maria Satya Paramitha
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Rino Alvani Gani
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Laurentius A. Lesmana
- Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia
- Gastrointestinal Cancer Center, MRCCC Siloam Semanggi Hospital, Jakarta, Indonesia
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Takasu A, Iwao A, Tang X. Utility of a novel self-assembling peptide for bleeding from the specimen side during gastric endoscopic submucosal dissection. Dig Endosc 2023; 35:e16-e17. [PMID: 36380522 DOI: 10.1111/den.14458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Ayaka Takasu
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Aya Iwao
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Xiaoyan Tang
- Department of Pathology, Nihon University School of Medicine, Tokyo, Japan
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Abstract
The risk-benefit profile of submucosal endoscopic procedures is generally favorable but there exist unique considerations regarding the recognition, treatment, and prevention of submucosal endoscopic complications. Bleeding during the procedure can be managed with knife electrocautery, tamponade by injection of additional submucosal agent, or hemostatic forceps, depending on the location and degree of bleeding. Delayed bleeding should be managed with repeat endoscopy. Potential means to reduce the risk of delayed bleeding include anticipatory coagulation of visible vessels in the dissection ulcer base, applied hemostatic chemicals, snares, clips, and sheets of cultured cells.
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Affiliation(s)
- Manu Venkat
- Department of Medicine, Columbia University Irving Medical Center, New York Presbyterian Hospital, 5141 Broadway, New York, NY 10034, USA
| | - Kavel Visrodia
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York Presbyterian Hospital, Herbert Irving Pavilion, 161 Fort Washington Avenue, 8th Floor, Street 852A, New York, NY 10032, USA.
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Miyano A, Ogura T, Nishikawa H. Noninvasive endoscopic hemostasis technique for post-papillectomy bleeding using a novel self-assembling peptide (with video). JGH Open 2022; 7:81-82. [PMID: 36660055 PMCID: PMC9840193 DOI: 10.1002/jgh3.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022]
Abstract
Although a novel hemostatic agent has been used for endoscopic mucosal resection in submucosal dissection, there are few case reports of its use in pancreato-biliary endoscopic procedures. We describe a case of post-endoscopic papillectomy bleeding in which endoscopic hemostasis was achieved using a novel hemostatic agent.
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Affiliation(s)
- Akira Miyano
- 2nd Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | - Takeshi Ogura
- 2nd Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | - Hiroki Nishikawa
- 2nd Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
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Uba Y, Ogura T, Ueno S, Okuda A, Nishioka N, Miyano A, Yamamoto Y, Bessho K, Tomita M, Nakamura J, Hakoda A, Nishikawa H. Comparison of Endoscopic Hemostasis for Endoscopic Sphincterotomy Bleeding between a Novel Self-Assembling Peptide and Conventional Technique. J Clin Med 2022; 12:jcm12010079. [PMID: 36614880 PMCID: PMC9821301 DOI: 10.3390/jcm12010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction: Recently, a novel self-assembling peptide hemostatic gel has become available in Japan. However, the safety and efficacy of this novel self-assembling peptide hemostatic gel remain unclear for bleeding after EST. The aim of this study was to evaluate the safety and efficacy of a novel self-assembling peptide hemostatic gel for bleeding after EST, and to perform a comparison to a conventional endoscopic hemostasis technique. Method: This retrospective study was carried out between January 2019 and October 2022. Patients who developed bleeding associated with EST were enrolled. The patients were divided into two groups based on the hemostasis technique used: a conventional hemostasis technique (Group A) or a novel self-assembling peptide hemostatic gel hemostasis technique (Group B). Result: A total of 62 patients (Group A, n = 36; Group B, n = 26) were included. Endoscopic hemostasis was initially obtained in 72.2% (26/32) of patients in Group A and in 88.4% (23/26) of patients in Group B, which was not significantly different (p = 0.1320). However, the procedure time was significantly shorter in Group B (mean, 9.38 min) compared with Group A (mean, 15.4 min) (p = 0.0103). There were no significant differences in the severity of bleeding between the two groups (p = 0.4530). Post-EST bleeding was observed in six patients (Group A, n = 4; Group B, n = 2). Adverse events were more frequently observed in Group A (n = 12) than in Group B (n = 1) (p = 0.0457). Conclusions: PuraStat application for EST bleeding might be safe and effective, and is comparable to the conventional endoscopic hemostasis technique, although further prospective randomized trials are needed.
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Affiliation(s)
- Yuki Uba
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
- Endoscopy Center, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
- Correspondence: ; Tel.: +81-7-2683-1221; Fax: +81-72-6846-532
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Akira Miyano
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Yoshitaro Yamamoto
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Kimi Bessho
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Mitsuki Tomita
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Junichi Nakamura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Akitoshi Hakoda
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka 565-0871, Japan
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Li M, Jin X, Zhou X, Lou G, Ji F, Wang L, Jin H, Huang X, Zhao J, Bao H, Huang L, Shi C, Jin B, Lu H, Lyu B. Effectiveness and safety of a newly designed self-assembling gel in the treatment of endoscopic submucosal dissection-induced gastric ulcer: A multicenter randomized controlled trial. Front Pharmacol 2022; 13:1002381. [DOI: 10.3389/fphar.2022.1002381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: To evaluate the effectiveness and safety of a newly designed self-assembling gel in treating ESD-induced gastric ulcers in patients.Methods: This open-label, multicenter, randomized controlled trial enrolled patients who underwent ESD between September 2020 and May 2021. Patients were randomized (1:1) to receive the gel (applied to cover the entire ulcer bed under endoscopic guidance immediately after ESD; gel group) or not (control group). The primary outcome was the ulcer healing rate at 28 days. And the secondary outcomes were the delayed bleeding, changes in the ulcer stage, and adverse events.Results: Finally, 125 patients (mean age, 63.7 years; 70 [56.0%] males) were enrolled. The ulcer healing rate was higher in the gel group than in the control group at 28 days (96.9 ± 4.1% vs. 94.7 ± 5.0%; p = 0.001). The ulcer reduction rate at 28 days differed significantly (p < 0.001) between ulcers with majority gel coverage (99.8%), ulcers with minority gel coverage (96.2%), and ulcers with no gel coverage (98.0%). Delayed bleeding was found in 1/63 gel-treated patients (1.6%) versus 5/62 controls (8.1%). A1-stage ulcers were found in 16/63 patients in the gel group versus 44/62 patients in the control group (25.4% vs. 71.0%, p < 0.001) at 3–5 days.Conclusion: The newly developed self-assembling gel was safe and effective in accelerating gastric ulcer healing in patients after ESD.Clinical Trial Registration: UMIN Clinical Trials Registry System (registration number, ChiCTR2100052935).
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Toyonaga H, Hayashi T, Hama K, Nakamura R, Iwano K, Takahashi K, Katanuma A. Rapid hemostasis using a self-assembling peptide matrix for midprocedural bleeding in endoscopic sphincterotomy. Endoscopy 2022; 55:E218-E219. [PMID: 36400053 PMCID: PMC9829968 DOI: 10.1055/a-1960-3198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Kazuki Hama
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Risa Nakamura
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Kosuke Iwano
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
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Toyonaga H, Hayashi T, Nakamura R, Iwano K, Kin T, Takahashi K, Katanuma A. Effective application of self-assembling peptide matrix with the gel immersion technique and red dichromatic imaging for hemostasis of postendoscopic sphincterotomy bleeding. Endoscopy 2022; 55:E72-E73. [PMID: 36179720 PMCID: PMC9829793 DOI: 10.1055/a-1929-9038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Risa Nakamura
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Kosuke Iwano
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
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Bulking agents in gastrointestinal endoscopy: present applications and future advances. Curr Opin Gastroenterol 2022; 38:472-480. [PMID: 35881970 DOI: 10.1097/mog.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Bulking agents are inert materials injected into an organ to affect the physical properties of the organ for a therapeutic purpose. Various agents have been developed to aid in the treatment of diseases like gastroesophageal reflux disease (GERD), fecal incontinence, obesity, malignancy, hemostasis, and tissue dissection. Here, we review the state of the art in bulking agents in gastrointestinal endoscopy, past failures, current limitations, and where we see the field heading in the future. RECENT FINDINGS Though bulking agents have been trialed for various different gastrointestinal diseases, there are currently limited uses in gastrointestinal endoscopy. Though various agents have been trialed for GERD, numerous complications and adverse events have limited its current use. However, for the treatment of fecal incontinence endoscopic bulking agent therapy is a reasonable option. Though in early stages of exploration, bulking agent therapy for enteric protection from radiotherapy may be a promising tool to improve treatment of pancreatic cancer. Bulking agents for tissue dissection have substantially improved lifting agents and complex polyp removal. Bulking agent therapy has not really been explored for endoscopic bariatric therapy or hemostasis but may be a fruitful area for exploration in the future. SUMMARY Bulking agent therapy has been trialed for various gastrointestinal diseases with mixed success. There is currently a therapeutic roll in the endoscopic management of fecal incontinence and tissue dissection. A future role in the treatment of GERD, obesity, malignancy, and hemostasis seem feasible.
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Jiang W, Cen L, Dong C, Zhu S, Shen Z, Li D. Prophylactic Clipping to Prevent Delayed Bleeding and Perforation After Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:643-653. [PMID: 35648969 DOI: 10.1097/mcg.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS To help prevent delayed adverse events after endoscopic surgery, endoscopists often place clips at the site. This meta-analysis aimed to assess the efficacy and safety of prophylactic clipping in the prevention of delayed bleeding and perforation after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). METHODS Multiple databases were searched from the inception dates to April 2021. And we included all relevant studies. Pooled odds ratio comparing the prophylactic clipped group versus nonprophylactic clipped group were calculated using the random effects model. RESULTS Twenty-seven articles fulfilled the inclusion criteria, with a total size of 8693 participants. There was statistically significant difference in prophylactic clipping versus no prophylactic clipping for delayed bleeding and perforation found in all studies (odds ratio: 0.35, 95% confidence interval: 0.25-0.49, P <0.01; odds ratio: 0.42, 95% confidence interval: 0.21-0.83, P <0.05; respectively). Besides, statistically significant difference was also found in subgroup analyses based on patients with lesions larger than 20 mm. Prophylactic clipping was more protective for duodenal delayed adverse events than colorectum. The use of clip closure was more protective to ESD-related delayed adverse events than EMR. CONCLUSIONS Prophylactic clipping after ESD and EMR was beneficial in preventing delayed bleeding and perforation.
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Affiliation(s)
- Wenxi Jiang
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Li Cen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Caijuan Dong
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Shefeng Zhu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Zhe Shen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Dong Li
- Department of Gastroenterology, The First People's Hospital of Wenling, Taizhou, China
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Jiang SX, Chahal D, Ali-Mohamad N, Kastrup C, Donnellan F. Hemostatic powders for gastrointestinal bleeding: a review of old, new, and emerging agents in a rapidly advancing field. Endosc Int Open 2022; 10:E1136-E1146. [PMID: 36238531 PMCID: PMC9552790 DOI: 10.1055/a-1836-8962] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/20/2022] [Indexed: 10/26/2022] Open
Abstract
Background and study aims Hemostatic powders are increasingly used to address limitations in conventional endoscopic techniques for gastrointestinal bleeding. Various agents exist with different compositions, characteristics, efficacy, and adverse events (AEs). We sought to review existing hemostatic powders, from preclinical to established agents. Methods A literature review on hemostatic powders for gastrointestinal bleeding was undertaken through a MEDLINE search from 2000-2021 and hand searching of articles. Relevant literature was critically appraised and reviewed for mechanism of action, hemostasis and rebleeding rate, factors associated with hemostatic failure, and AEs. Results The most established agents are TC-325 (Hemospray), EndoClot, and Ankaferd Blood Stopper (ABS). These agents have been successfully applied to a variety of upper and lower gastrointestinal bleeding etiologies, in the form of primary, combination, salvage, and bridging therapy. Few AEs have been reported, including visceral perforation, venous embolism, and self-limited abdominal pain. Newer agents include CEGP-003 and UI-EWD, which have shown results similar to those for the older agents in initial clinical studies. All aforementioned powders have high immediate hemostasis rates, particularly in scenarios not amenable to conventional endoscopic methods, but are limited by significant rates of rebleeding. Other treatments include TDM-621 (PuraStat) consisting of a liquid hemostatic agent newly applied to endoscopy and self-propelling thrombin powder (CounterFlow Powder), a preclinical but promising agent. Conclusions Rapid development of hemostatic powders and growing clinical expertise has established these agents as a valuable strategy in gastrointestinal bleeding. Further research will continue to refine the efficacy and applicability of these agents.
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Affiliation(s)
- Shirley X. Jiang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daljeet Chahal
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | - Nabil Ali-Mohamad
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christian Kastrup
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada,Blood Research Institute, Versiti, Milwaukee, Wisconsin, United States
| | - Fergal Donnellan
- Division of Gastroenterology, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
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Götz M, Biecker E, Dechêne A, Schilling D, Zipprich A, Trebicka J. [Not Available]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:1139-1145. [PMID: 35817045 DOI: 10.1055/a-1788-3501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Martin Götz
- Medizinische Klinik IV - Gastroenterologie/Onkologie, Klinikum Sindelfingen-Böblingen, Böblingen, Deutschland
| | - Erwin Biecker
- Abteilung Innere Medizin mit Schwerpunkt Gastroenterologie, Zollernalb Klinikum Balingen, Balingen, Deutschland
| | - Alexander Dechêne
- Medizinische Klinik 6 mit Schwerpunkt Gastroenterologie, Klinikum Nord, Nürnberg, Deutschland
| | - Dieter Schilling
- Medizinische Klinik II mit Schwerpunkt Gastroenterologie, Diakonissenkrankenhaus Mannheim, Mannheim, Deutschland
| | - Alexander Zipprich
- Klinik für Innere Medizin IV Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Jonel Trebicka
- Medizinische Klinik B für Gastroenterologie und Hepatologie, Universitätsklinikum Münster, Münster, Deutschland
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Hao Z, Li H, Wang Y, Hu Y, Chen T, Zhang S, Guo X, Cai L, Li J. Supramolecular Peptide Nanofiber Hydrogels for Bone Tissue Engineering: From Multihierarchical Fabrications to Comprehensive Applications. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2103820. [PMID: 35128831 PMCID: PMC9008438 DOI: 10.1002/advs.202103820] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/02/2022] [Indexed: 05/03/2023]
Abstract
Bone tissue engineering is becoming an ideal strategy to replace autologous bone grafts for surgical bone repair, but the multihierarchical complexity of natural bone is still difficult to emulate due to the lack of suitable biomaterials. Supramolecular peptide nanofiber hydrogels (SPNHs) are emerging biomaterials because of their inherent biocompatibility, satisfied biodegradability, high purity, facile functionalization, and tunable mechanical properties. This review initially focuses on the multihierarchical fabrications by SPNHs to emulate natural bony extracellular matrix. Structurally, supramolecular peptides based on distinctive building blocks can assemble into nanofiber hydrogels, which can be used as nanomorphology-mimetic scaffolds for tissue engineering. Biochemically, bioactive motifs and bioactive factors can be covalently tethered or physically absorbed to SPNHs to endow various functions depending on physiological and pharmacological requirements. Mechanically, four strategies are summarized to optimize the biophysical microenvironment of SPNHs for bone regeneration. Furthermore, comprehensive applications about SPNHs for bone tissue engineering are reviewed. The biomaterials can be directly used in the form of injectable hydrogels or composite nanoscaffolds, or they can be used to construct engineered bone grafts by bioprinting or bioreactors. Finally, continuing challenges and outlook are discussed.
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Affiliation(s)
- Zhuowen Hao
- Department of OrthopedicsZhongnan Hospital of Wuhan UniversityDonghu Road 169Wuhan430071China
| | - Hanke Li
- Department of OrthopedicsZhongnan Hospital of Wuhan UniversityDonghu Road 169Wuhan430071China
| | - Yi Wang
- Department of OrthopedicsZhongnan Hospital of Wuhan UniversityDonghu Road 169Wuhan430071China
| | - Yingkun Hu
- Department of OrthopedicsZhongnan Hospital of Wuhan UniversityDonghu Road 169Wuhan430071China
| | - Tianhong Chen
- Department of OrthopedicsZhongnan Hospital of Wuhan UniversityDonghu Road 169Wuhan430071China
| | - Shuwei Zhang
- Department of OrthopedicsZhongnan Hospital of Wuhan UniversityDonghu Road 169Wuhan430071China
| | - Xiaodong Guo
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Road 1277Wuhan430022China
| | - Lin Cai
- Department of OrthopedicsZhongnan Hospital of Wuhan UniversityDonghu Road 169Wuhan430071China
| | - Jingfeng Li
- Department of OrthopedicsZhongnan Hospital of Wuhan UniversityDonghu Road 169Wuhan430071China
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Bendall O, James J, Pawlak KM, Ishaq S, Tau JA, Suzuki N, Bollipo S, Siau K. Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients. Clin Exp Gastroenterol 2022; 14:477-492. [PMID: 34992406 PMCID: PMC8714413 DOI: 10.2147/ceg.s282699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/02/2021] [Indexed: 12/13/2022] Open
Abstract
Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3–1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summary of factors that contribute to the risk of DPPB before discussing pragmatic interventions to mitigate their risk and improve patient safety.
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Affiliation(s)
- Oliver Bendall
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Joel James
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Katarzyna M Pawlak
- Endoscopy Unit, Department of Gastroenterology, Ministry of Interior and Administration, Szczecin, Poland
| | - Sauid Ishaq
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK.,Medicine, Birmingham City Hospital, Birmingham, UK
| | - J Andy Tau
- Austin Gastroenterology, Austin, TX, USA
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St. Mark's Hospital, London, UK
| | - Steven Bollipo
- School of Medicine & Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK
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Gil ES, Aleksi E, Spirio L. PuraStat RADA16 Self-Assembling Peptide Reduces Postoperative Abdominal Adhesion Formation in a Rabbit Cecal Sidewall Injury Model. Front Bioeng Biotechnol 2021; 9:782224. [PMID: 34957076 PMCID: PMC8703061 DOI: 10.3389/fbioe.2021.782224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/26/2021] [Indexed: 01/13/2023] Open
Abstract
Objective: To evaluate the effect of PuraStat (2.5% RADA16) administration on postoperative abdominal adhesion formation in an in vivo model. Methods: Anesthetized New Zealand white rabbits underwent cecal sidewall abrasion surgery in which the cecal serosa and juxtaposed parietal peritoneum were abraded after access through an abdominal midline incision. Eight animals were randomized to receive PuraStat administration at the interface of the injured tissues before incision closure, and five animals served as untreated controls. Treated animals received 3–12 ml PuraStat solution per lesion. Animals were sacrificed 14 days after surgery and examined for adhesion formation at the wound site. Results: At study terminus, adhesions were identified in 90% (9/10) of abraded cecum/peritoneal wound sites in untreated controls versus 25% (4/16) of PuraStat-treated sites (p = 0.004). Mean ± SD Total Adhesion Score (average of the values for extent + strength of the adhesion in both defects per animal; maximum score = 14 points) was significantly 76% lower in PuraStat-treated animals (2.0 ± 3.0 points) compared to untreated controls (8.2 ± 1.9 points) (p = 0.029). Mean adhesion coverage area of wound sites was 79% lower in PuraStat-treated animals than controls (p < 0.001), and mean adhesion durability was 72% lower in PuraStat-treated animals versus controls (p = 0.005). Remnant hydrogel was observed at the wound sites of 75% of treated animals at postoperative Day 14. Conclusion: PuraStat treatment has a positive protective effect in the cecal sidewall injury model, and significantly reduces abdominal adhesion formation at the interface of the injured cecum and overlying peritoneal sidewall defect.
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Verbraeken B, Lammens M, Van Rompaey V, Ahmed M, Szewczyk K, Hermans C, Menovsky T. Efficacy and histopathological effects of self-assembling peptides RADA16 and IEIK13 in neurosurgical hemostasis. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2021; 40:102485. [PMID: 34748959 DOI: 10.1016/j.nano.2021.102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/13/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
There is a continued need for effective hemostatic agents that are safe for neurosurgical use. Self-assembling peptide hydrogels have been suggested as novel hemostatic agents. They offer some advantages for neurosurgical hemostasis (e.g., transparency), but their efficacy and safety for neurosurgery has not been established. In this paper, the efficacy and safety of two self-assembling peptides, RADA16 and IEIK13, are explored for hemostasis of oozing bleeding on the rat cerebral cortex (n=56). Chronic safety was evaluated by neuropathological evaluation at one, four, and twelve weeks after craniotomy (n=32). An inactive control and oxidized cellulose served as comparators. Mean time-to-hemostasis was significantly shorter for RADA16 and IEIK13 compared to controls, while safety evaluation yielded similar results. Histopathological response consisted primarily of macrophage infiltration at the lesion site in all groups. This study confirms the hemostatic potential and safety of RADA16 and IEIK13 for hemostasis in the rat brain.
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Affiliation(s)
- Barbara Verbraeken
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Neurosurgery, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Martin Lammens
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Pathology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Vincent Van Rompaey
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Melek Ahmed
- Department of Pathology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Krystyna Szewczyk
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Christophe Hermans
- Department of Pathology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium; Center for Oncological Research (CORE), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Tomas Menovsky
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Neurosurgery, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
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Li F, Gao L, Zhang X, Wang P, Liu Y, Feng J, Zhang C, Zhao C, Zhang S. "PP-type" self-assembling peptides with superior rheological properties. NANOSCALE ADVANCES 2021; 3:6056-6062. [PMID: 36133953 PMCID: PMC9417066 DOI: 10.1039/d1na00534k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/01/2021] [Indexed: 06/16/2023]
Abstract
The ionic-complementary self-assembling peptides discovered by Zhang Shuguang have solution-to-gel (sol-gel) transition capacity and one such peptide RADA16 has been commercialized into hemostatic agents. However, their sol-gel transition ability was not obvious because the peptide aqueous solution with a concentration greater than 1% w/v appeared to be thick and viscous. The current report describes PP-type self-assembling peptides. In addition to the ionic-complementary sequence, they have prolines at both ends of the sequence. This feature has led to better solubility, lower viscosity of the peptide solution, and simplified synthesis and purification processes while maintaining the great gelling performance of the ionic-complementary peptides. The PP-type peptides self-assembled into a well-organized nanofiber scaffold as shown by TEM. Among the PP-type peptides, the PRVDP9 sequence peptide was tested as a hemostatic agent and a mucosal elevating agent. The results were comparable to the classic RADA16. The PP-type self-assembling peptides have superior sol-gel transition ability. Therefore, it is predicted that they will be more suitable to be transported through catheters or endoscopes and have higher commercialization potential as compared with the classic self-assembling peptide sequences.
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Affiliation(s)
- Fangmin Li
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
| | - Lichang Gao
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
| | - Xudong Zhang
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
| | - Pin Wang
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
| | - Yuanxue Liu
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
| | - Jinhui Feng
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
| | - Chunxia Zhang
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
| | - Chengru Zhao
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
| | - Shang Zhang
- Success Bio-Tech Co., Ltd. 2222 Kaituo Road Jinan 250101 China
- Biomedical Material Engineering Laboratory of Shandong Province 2222 Kaituo Road Jinan 250101 China
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Stefan S, Wagh M, Siddiqi N, Naqvi S, Rawlinson E, Shepherd A, Khan J. Self-assembling peptide haemostatic gel reduces incidence of pelvic collection after total mesorectal excision: Prospective cohort study. Ann Med Surg (Lond) 2021; 68:102553. [PMID: 34434548 PMCID: PMC8376673 DOI: 10.1016/j.amsu.2021.102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pelvic surgery has the potential to leave behind a large raw surface, which can bleed and ooze postoperatively. The adoption of precision surgical approach for rectal cancers has led to reduction in blood loss. We aimed to assess 1) the feasibility and 2) the safety of using a self-assembling peptide (SAP) haemostatic agent (PuraStat®) after rectal cancer surgery to reduce the incidence of pelvic collections. MATERIALS AND METHODS This prospective cohort pilot study compared the results of 25 consecutive cases of total mesorectal excision (TME) with use of 5-10 ml of SAP, and 25 consecutive cases without PuraStat® application (CON, control group). The groups were compared for complications (Clavien-Dindo grade III and IV classification), postoperative drain output and length of hospital stay (LOS). Statistical analysis was carried out using paired samples T test and Fisher's exact test. RESULTS Fifty patients (SAP = 25, CON = 25) were enrolled into this study. Mean drain outputs (ml) on day 1, day 2 and day 3 were 60 ± 18, 89 ± 42 and 64 ± 45 in SAP group, and 102 ± 31, 95 ± 52, 66 ± 37 in CON group. This was significantly better for SAP group in day one after surgery. The mean LOS was shorter in SAP group (5.7 versus 7.4 days in CON, p 0.04). Clavien-Dindo III & IV complications were seen in two and five cases respectively (p 0.18). R0 resection rate (p 0.32) and lymph node harvest (p 0.13) were similar in both groups. There were no complications seen in relation to the application of the SAP. CONCLUSIONS These initial data suggest that SAP is a safe product, and feasible to apply in the pelvis after TME surgery. It appears to shorten the LOS and reduce the postoperative drain output and may reduce the incidence of Clavien-Dindo grade III & IV complications.
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Affiliation(s)
- Samuel Stefan
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Mira Wagh
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Syed Naqvi
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Emma Rawlinson
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Anthony Shepherd
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, UK
| | - Jim Khan
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Professor of Surgery, University of Portsmouth, UK
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Branchi F, Klingenberg-Noftz R, Friedrich K, Bürgel N, Daum S, Buchkremer J, Sonnenberg E, Schumann M, Treese C, Tröger H, Lissner D, Epple HJ, Siegmund B, Stroux A, Adler A, Veltzke-Schlieker W, Autenrieth D, Leonhardt S, Fischer A, Jürgensen C, Pape UF, Wiedenmann B, Möschler O, Schreiner M, Strowski MZ, Hempel V, Huber Y, Neumann H, Bojarski C. PuraStat in gastrointestinal bleeding: results of a prospective multicentre observational pilot study. Surg Endosc 2021; 36:2954-2961. [PMID: 34129089 PMCID: PMC9001238 DOI: 10.1007/s00464-021-08589-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
Background A recently developed haemostatic peptide gel for endoscopic application has been introduced to improve the management of gastrointestinal bleeding. The aim of this pilot study was to evaluate the feasibility, safety, efficacy and indication profiles of PuraStat in a clinical setting. Methods In this prospective observational multicentre pilot study, patients with acute non-variceal gastrointestinal bleeding (upper and lower) were included. Primary and secondary application of PuraStat was evaluated. Haemoglobin, prothrombin time, platelets and transfusion behaviour were documented before and after haemostasis. The efficacy of PuraStat was assessed during the procedure, at 3 days and 1 week after application. Results 111 patients with acute gastrointestinal bleeding were recruited into the study. 70 percent (78/111) of the patients had upper gastrointestinal bleeding and 30% (33/111) had lower gastrointestinal bleeding. After primary application of PuraStat, initial haemostatic success was achieved in 94% of patients (74/79, 95% CI 88–99%), and in 75% of the patients when used as a secondary haemostatic product, following failure of established techniques (24/32, 95% CI 59–91%). The therapeutic success rates (absence of rebleeding) after 3 and 7 days were 91% and 87% after primary use, and 87% and 81% in all study patients. Overall rebleeding rate at 30 day follow-up was 16% (18/111). In the 5 patients who finally required surgery (4.5%), PuraStat allowed temporary haemostasis and stabilisation. Conclusions PuraStat expanded the therapeutic toolbox available for an effective treatment of gastrointestinal bleeding sources. It could be safely applied and administered without complications as a primary or secondary therapy. PuraStat may additionally serve as a bridge to surgery in order to achieve temporary haemostasis in case of refractory severe bleeding, possibly playing a role in preventing immediate emergency surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08589-6.
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Affiliation(s)
- Federica Branchi
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Rolf Klingenberg-Noftz
- DRK-Krankenhaus Grevesmühlen, Gastroenterologie und Allgemeine Innere Medizin, Klützer Straße 13-15, 23936, Grevesmühlen, Germany
| | - Kristina Friedrich
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Nataly Bürgel
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Severin Daum
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Juliane Buchkremer
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Elena Sonnenberg
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Michael Schumann
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christoph Treese
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hanno Tröger
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Donata Lissner
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hans-Jörg Epple
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Britta Siegmund
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Andrea Stroux
- Institut für Biometrie und Klinische Epidemiologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Andreas Adler
- Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Winfried Veltzke-Schlieker
- Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daniel Autenrieth
- Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Silke Leonhardt
- Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Fischer
- Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Jürgensen
- Campus Mitte, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Virchowweg 10, 10117, Berlin, Germany
| | - Ulrich-Frank Pape
- Campus Mitte, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Virchowweg 10, 10117, Berlin, Germany
| | - Bertram Wiedenmann
- Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Campus Mitte, Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Virchowweg 10, 10117, Berlin, Germany
| | - Oliver Möschler
- Niels-Stensen-Kliniken, Marienhospital Osnabück GmbH, Bischhofstraße 1, 49074, Osnabrück, Germany
| | - Maximilian Schreiner
- Bundeswehrkrankenhaus Berlin, Klinik für Innere Medizin, Scharnhorststraße 13, 10115, Berlin, Germany
| | - Mathias Z Strowski
- Park-Klinik Weißensee, Gastroenterologie und Onkologie, Klinik für Innere Medizin, Schönstr. 80, 13086, Berlin, Germany
| | - Volkmar Hempel
- Klinikum Mittleres Erzgebirge gGmbH, Klinik für Innere Medizin, Alte Marienberger Straße 52, 09405, Zschopau, Germany
| | - Yvonne Huber
- I. Medizinische Klinik Und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Helmut Neumann
- I. Medizinische Klinik Und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Christian Bojarski
- Campus Benjamin Franklin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
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Sankar S, O’Neill K, Bagot D’Arc M, Rebeca F, Buffier M, Aleksi E, Fan M, Matsuda N, Gil ES, Spirio L. Clinical Use of the Self-Assembling Peptide RADA16: A Review of Current and Future Trends in Biomedicine. Front Bioeng Biotechnol 2021; 9:679525. [PMID: 34164387 PMCID: PMC8216384 DOI: 10.3389/fbioe.2021.679525] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
RADA16 is a synthetic peptide that exists as a viscous solution in an acidic formulation. In an acidic aqueous environment, the peptides spontaneously self-assemble into β-sheet nanofibers. Upon exposure and buffering of RADA16 solution to the physiological pH of biological fluids such as blood, interstitial fluid and lymph, the nanofibers begin physically crosslinking within seconds into a stable interwoven transparent hydrogel 3-D matrix. The RADA16 nanofiber hydrogel structure closely resembles the 3-dimensional architecture of native extracellular matrices. These properties make RADA16 formulations ideal topical hemostatic agents for controlling bleeding during surgery and to prevent post-operative rebleeding. A commercial RADA16 formulation is currently used for hemostasis in cardiovascular, gastrointestinal, and otorhinolaryngological surgical procedures, and studies are underway to investigate its use in wound healing and adhesion reduction. Straightforward application of viscous RADA16 into areas that are not easily accessible circumvents technical challenges in difficult-to-reach bleeding sites. The transparent hydrogel allows clear visualization of the surgical field and facilitates suture line assessment and revision. The shear-thinning and thixotropic properties of RADA16 allow its easy application through a narrow nozzle such as an endoscopic catheter. RADA16 hydrogels can fill tissue voids and do not swell so can be safely used in close proximity to pressure-sensitive tissues and in enclosed non-expandable regions. By definition, the synthetic peptide avoids potential microbiological contamination and immune responses that may occur with animal-, plant-, or mineral-derived topical hemostats. In vitro experiments, animal studies, and recent clinical experiences suggest that RADA16 nanofibrous hydrogels can act as surrogate extracellular matrices that support cellular behavior and interactions essential for wound healing and for tissue regenerative applications. In the future, the unique nature of RADA16 may also allow us to use it as a depot for precisely regulated drug and biopharmaceutical delivery.
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Lorenzo-Zúñiga V, Bustamante-Balén M, Pons-Beltrán V. Prevention of late complications with coverage agents in endoscopic resection of colorectal lesions: Current landscape in gastrointestinal endoscopy. World J Gastroenterol 2021; 27:1563-1568. [PMID: 33958843 PMCID: PMC8058649 DOI: 10.3748/wjg.v27.i15.1563] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic removal of large (≥ 20 mm) non-pedunculated colorectal lesions (LNPCLs) may result in major adverse events, such as delayed bleeding (DB) and delayed perforation (DP), despite closure of the mucosal defects with clips. Topical application of a coverage agent refers to the creation of a shield with a biocompatible medical device (tissue or hydrogel) with proven bioactive properties. Coverage of the eschar after endoscopic resection provides shielding protection to prevent delayed complications. The aim of the present review was to systematically collect and review the currently available literature regarding the prevention of DB and DP with coverage agents after endoscopic mucosal resection or endoscopic submucosal dissection of LNPCLs.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia 46026, Spain
| | | | - Vicente Pons-Beltrán
- Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia 46026, Spain
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