Efficacy and safety of a self-assembling peptide hemostatic gel in the treatment of bleeding in endoscopic ultrasound-guided drainage and direct endoscopic necrosectomy of pancreatic fluid collections

Abstract

Background and aims: EUS-guided drainage and direct endoscopic necrosectomy (DEN) are primary treatment modalities for symptomatic pseudocysts and walled-off pancreatic necrosis (WOPN). Bleeding is a serious adverse event associated with drainage, also occurring because of lack of effective endoscopic hemostatic techniques. PuraStat (3-D Matrix, Tokyo, Japan) has demonstrated excellent results in the management of GI bleeding. Our aim was to evaluate the efficacy and safety of this hemostatic gel in managing bleeding secondary to EUS-guided drainage and DEN of pancreatic fluid collections (PFCs).

Methods: In this multicenter, retrospective, observational study, 27 patients underwent PuraStat treatment because of active bleeding during or after PFC EUS-guided drainage or WOPN DEN sessions between 2017 and 2024.

Results: In total, 38 bleeding episodes were recorded. The bleeding type was oozing in 36 cases and spurting in 2 cases. PuraStat was successfully applied in 100% of patients and achieved successful hemostasis in 96.5% of cases.

Conclusions: This novel hemostatic gel is a safe and effective way to manage oozing bleeds related to EUS-guided drainage or DEN of PFCs.