Hemostasis Peptide Reduces Need for Electrocoagulation of Bleeding Points During ESD

Bleeding is common during endoscopic submucosal dissection (ESD). It can obscure dissection planes and often requires electrocoagulation that could injure the muscularis propria. PuraStat (3D-Matrix, Europe SAS, France) is a clear gel that can be injected through a catheter to form a scaffold over a bleeding point. Previous studies have suggested the gel can control nonarterial bleeding, reduce delayed bleeding, and promote wound healing. Unlike clip placement and powdered sprays, its use during resection does not impede continued resection.

In a trial of 101 patients in the United Kingdom, esophageal and colorectal ESD cases were randomized to treatment of bleeding with electrocoagulation only versus a combination of gel and electrocoagulation. All procedures were performed by a single expert. In the gel arm, arterial spurting and easily visible nonarterial bleeding points were treated with electrocoagulation, whereas nonarterial bleeding without an easily visible bleeding point was treated with gel.

In the gel arm, 49.3% of bleeds were treated with diathermy, compared to 99.6% in the control arm. Of the bleeds treated with gel, 93% responded with bleeding cessation. There was no difference in delayed bleeds between arms. Blinded assessment of healing at 4 weeks found complete wound healing in 49% treated with gel versus 25% with control.