P2107 - Control of Variceal Hemorrhage Using a Hemostatic Peptide Gel as Means to Rescue: A Novel Approach

Varun Moktan, MD¹, Adrian Pona, MD¹, Diego Lim, MD, MPH¹, Christina M. Bauer, MD, MPH¹, Veeral M. Oza, MD^2
1Prisma Health-Upstate, Greenville, SC; ²Prisma Health, Greenville, SC

Introduction: Variceal hemorrhage is a life-threatening complication of portal hypertension requiring immediate management. Band ligation remains a primary treatment strategy. However, active bleeding can interfere with direct visualization of the bleeding varix and where to deploy the band. We present a novel case report of a hemostatic peptide gel (Purastat) used to control a spurting variceal bleed to achieve control of the bleed so that band ligation could be performed

Case Description/Methods: A 39-year-old male with decompensated alcoholic cirrhosis presented with large volume hematemesis. Emergent upper endoscopy revealed bleeding grade III esophageal varices. After loading the banding unit onto the scope, and upon re-introduction of the scope into the esophagus, a varix was seen with spurting blood (Figure A) making visualization difficult. To improve visualization, 2mL of PuraStat was used with immediate bleeding cessation (Figure B). We then continued band ligation for a total of nine deployed bands. The bleeding persisted despite the banding, hence additional 3mL more PuraStat was applied directly to the re-bleeding, banded varix and complete hemostasis was achieved. The patient ultimately recovered and did well

Discussion: The simultaneous use of PuraStat immediately prior to band ligation in an actively bleeding varix resulted in successful hemostasis of the spurting varix. This suggests PuraStat may serve as a valuable adjunct to band ligation in managing variceal hemorrhage, particularly in cases where rebleeding occurs immediately post-ligation. Previous studies report PuraStat had an initial hemostatic success rate of 94% and therapeutic success rates of 87% at 7 days following primary use in non-variceal gastrointestinal bleeding. Our case underscores the potential for expanding the use of PuraStat in the management of difficult to control variceal hemorrhage.



Disclosures:


Varun Moktan, MD¹, Adrian Pona, MD¹, Diego Lim, MD, MPH¹, Christina M. Bauer, MD, MPH¹, Veeral M. Oza, MD². P2107 - Control of Variceal Hemorrhage Using a Hemostatic Peptide Gel as Means to Rescue: A Novel Approach, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.