P3706 - Safety and Efficacy of Self-Assembling Peptide Gel in Prevention of Gastrointestinal Bleeding After Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection: A Single Center Experience

Ki-Yoon Kim, MD¹, Aidan Gross, ¹, Sofia Yuen, MD¹, Ashley Vareedayah, MD¹, Tamas Gonda, MD², Jonathan Cohen, MD¹, Lauren Khanna, MD¹, Amar Manvar, MD³, Jessica Widmer, MD⁴, Gregory Haber, MD^5
1NYU Langone, New York, NY; ²NYU Grossman School of Medicine, New York, NY; ³NYU Long Island, Mineola, NY; ⁴NYU Long Island, New York, NY; ⁵NYU, New York, NY

Introduction: Delayed bleeding can occur after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) in up to 15.6% of cases. Current hemostatic methods to minimize delayed bleeding risk have limitations. Epinephrine injection effect is transient. Excessive electrocoagulation may cause thermal damage or perforation. The location and the size of lesions may not permit use of endoclips or endoscopic suturing after endoscopic resection. Recently, a self-assembling peptide (SAP; Purastat) gel was developed as a hemostatic agent, which is applied as transparent, viscous gel via an endoscopic catheter (Figure 1). This study aims to evaluate the efficacy and safety of the peptide gel for prevention of delayed bleeding after large endoscopic resections.

Methods: A retrospective observational study was conducted at a tertiary medical center. Patient characteristics and size, location, and pathology of resected gastrointestinal lesions were extracted from the medical record. Primary outcomes were technical success (defined as successful application of the peptide gel), clinical success (absence of bleeding post procedure up to 30 days), and adverse events.

Results: 22 patients were included with follow up of 30 days. There were 16 ESD and 6 EMR cases. Baseline clinical and technical data are reported in Table 1. 9 patients (36%) were ASA III and 4 patients (16%) were on anticoagulation. Mean size of the lesion defect was 44.66+21.46 mm. The largest defect size was 100 mm from a circumferential ESD of an esophageal squamous cell carcinoma. Mean volume of the peptide gel used was 5.43+1.73 ml. Technical success rate was 100% (22/22). Clinical success rate at 30 days was 95.5% (21/22). One patient (4.5%) had bleeding seven days after circumferential ESD of a 50 mm lower esophageal adenocarcinoma. The patient required transfusion of one unit of packed red blood cells, a repeat endoscopy with hemostasis using electrocoagulation, and was discharged one day after admission. There were no treatment-related adverse events including mucosal injury, perforation, pain, allergic reaction, or thromboembolic events. No deaths were attributed to the procedure.

Discussion: Delayed bleeding can occur in up to 15.6% of all EMR or ESD cases. In very large defects, the risk is proportionally higher. The application of the self-assembling peptide gel is safe and is promising for reducing delayed bleeding risk after large endoscopic resection. Further large studies are necessary to validate these findings.



Disclosures:


Ki-Yoon Kim, MD¹, Aidan Gross, ¹, Sofia Yuen, MD¹, Ashley Vareedayah, MD¹, Tamas Gonda, MD², Jonathan Cohen, MD¹, Lauren Khanna, MD¹, Amar Manvar, MD³, Jessica Widmer, MD⁴, Gregory Haber, MD⁵. P3706 - Safety and Efficacy of Self-Assembling Peptide Gel in Prevention of Gastrointestinal Bleeding After Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection: A Single Center Experience, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.