BACKGROUND Hemostatic powders have been used as primary or salvage therapy to control gastrointestinal bleeding in a number of scenarios.PuraStat®is a novel,selfassembling peptide gel that has properties that dif...BACKGROUND Hemostatic powders have been used as primary or salvage therapy to control gastrointestinal bleeding in a number of scenarios.PuraStat®is a novel,selfassembling peptide gel that has properties that differ from hemostatic powders.It is transparent,can be used in narrow spaces and combined with other modalities.Also,it is pre-filled in a syringe ready to use and easy to handle and deliver.PuraStat®has been shown to be effective and safe in treating gastrointestinal bleeding lesions.But,its role as a hemostatic agent in all bleeding indications remains to be clarified.AIM To evaluate PuraStat®efficacy and its applications,feasibility and safety in treating gastrointestinal bleeding lesions.METHODS We performed a retrospective single-centre analysis of all consecutive patients with gastrointestinal bleeding,that required endoscopic treatment and where PuraStat®was applied,from June 2020 to October 2022.Demographics,biochemical,endoscopic,endoscopist assessment and outcome data were collected.We analysed the whole cohort and the subgroup with upper gastrointestinal bleeding.The primary outcome was to evaluate the efficacy of PuraStat®at achieving initial hemostasis.The patients were followed-up for 30 days after the episode of bleeding.RESULTS In total 45 patients were included,and 17/45(37.8%)females.The mean age was 65.8 years.Charlson score was>2 in 27/45(60%)and 26/45(57.8%)required transfusion.The procedures were gastroscopy(77.8%),colonoscopy(15.5%),endoscopic retrograde cholangiopancreatography(4.4%)and enteroscopy(2.2%).The most common bleeding lesion was peptic ulcer(33.3%).PuraStat®was used alone in 36%of the cases.One hundred percent achieved initial hemostasis and no complications were documented.There were no significant differences between the use of PuraStat®alone or in combination in terms of re-bleeding(P=0.64)or mortality(P=0.69).In 46.6%of cases,the reason for applying PuraStat®was as addition to standard of care,in 35.5%as an alternative because standard of care was not possible and in 17.8%as a rescue therapy.CONCLUSION PuraStat®is an effective therapy for multiple etiologies and is considered very easy to use in the majority.Its role as front line agent should be considered in the future.展开更多
BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major c...BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major concern in percutaneous techniques.Herein,we present a case of successful control of continuous oozing using a vascular closure device(VCD)and the application of Surgicel(Johnson&Johnson,United States)over the access tract.CASE SUMMARY An 82-year-old man presented with an unruptured abdominal aortic aneurysm measuring 83 mm×75 mm.The patient had a medical history of atrial fibrillation and was receiving rivaroxaban(15 mg/d).Routine pEVAR was performed using the preclose technique with ProGlide(Abbott,Santa Clara,CA,United States).Significant amount of bleeding was observed at the end of the procedure after the deployment of the closure device at the access site.A sheet of Surgicel was applied to the suture thread using a surgical needle.Surgicel was applied to the surface of the artery along the access tract using a pusher,and hemostasis was immediately attained.CONCLUSION This simple technique is an excellent adjunct to control residual bleeding from the access site following VCD use.展开更多
文摘BACKGROUND Hemostatic powders have been used as primary or salvage therapy to control gastrointestinal bleeding in a number of scenarios.PuraStat®is a novel,selfassembling peptide gel that has properties that differ from hemostatic powders.It is transparent,can be used in narrow spaces and combined with other modalities.Also,it is pre-filled in a syringe ready to use and easy to handle and deliver.PuraStat®has been shown to be effective and safe in treating gastrointestinal bleeding lesions.But,its role as a hemostatic agent in all bleeding indications remains to be clarified.AIM To evaluate PuraStat®efficacy and its applications,feasibility and safety in treating gastrointestinal bleeding lesions.METHODS We performed a retrospective single-centre analysis of all consecutive patients with gastrointestinal bleeding,that required endoscopic treatment and where PuraStat®was applied,from June 2020 to October 2022.Demographics,biochemical,endoscopic,endoscopist assessment and outcome data were collected.We analysed the whole cohort and the subgroup with upper gastrointestinal bleeding.The primary outcome was to evaluate the efficacy of PuraStat®at achieving initial hemostasis.The patients were followed-up for 30 days after the episode of bleeding.RESULTS In total 45 patients were included,and 17/45(37.8%)females.The mean age was 65.8 years.Charlson score was>2 in 27/45(60%)and 26/45(57.8%)required transfusion.The procedures were gastroscopy(77.8%),colonoscopy(15.5%),endoscopic retrograde cholangiopancreatography(4.4%)and enteroscopy(2.2%).The most common bleeding lesion was peptic ulcer(33.3%).PuraStat®was used alone in 36%of the cases.One hundred percent achieved initial hemostasis and no complications were documented.There were no significant differences between the use of PuraStat®alone or in combination in terms of re-bleeding(P=0.64)or mortality(P=0.69).In 46.6%of cases,the reason for applying PuraStat®was as addition to standard of care,in 35.5%as an alternative because standard of care was not possible and in 17.8%as a rescue therapy.CONCLUSION PuraStat®is an effective therapy for multiple etiologies and is considered very easy to use in the majority.Its role as front line agent should be considered in the future.
文摘BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major concern in percutaneous techniques.Herein,we present a case of successful control of continuous oozing using a vascular closure device(VCD)and the application of Surgicel(Johnson&Johnson,United States)over the access tract.CASE SUMMARY An 82-year-old man presented with an unruptured abdominal aortic aneurysm measuring 83 mm×75 mm.The patient had a medical history of atrial fibrillation and was receiving rivaroxaban(15 mg/d).Routine pEVAR was performed using the preclose technique with ProGlide(Abbott,Santa Clara,CA,United States).Significant amount of bleeding was observed at the end of the procedure after the deployment of the closure device at the access site.A sheet of Surgicel was applied to the suture thread using a surgical needle.Surgicel was applied to the surface of the artery along the access tract using a pusher,and hemostasis was immediately attained.CONCLUSION This simple technique is an excellent adjunct to control residual bleeding from the access site following VCD use.
