P0384 - Novel Hemostatic Agent as a Modality for Post-sphincterotomy Bleeding

Ahmed Ghanem, MD¹, Samuel Igbinedion, MD², Erik Holzwanger, MD³, Sultan Mahmood, MD³, Douglas Pleskow, MD, FACG⁴, Mandeep Sawhney, MD, MS³, Tyler Berzin, MD, FACG³, Moamen Gabr, MD, MSc,^3
1Mayo Clinic, Jacksonville, FL; ²Beth Israel Deaconess Medical Center, Harvard Medical School, Quincy, MA; ³Beth Israel Deaconess Medical Center, Boston, MA; ⁴BIDMC, Boston, MA

Introduction: Purastat, a synthetic hemostatic agent, has demonstrated promising efficacy and safety in the management of various types of bleeding, including upper and lower gastrointestinal bleeding ¹ , as well as bleeding associated with several surgical procedures ^2–4. However, its’ use in the management of post-sphincterotomy bleeding - a significant complication of ERCP, is still under-studied.

Case Description/Methods:

A 55-year-old man with alcohol-related cirrhosis (MELD-Na 16 points, Child-Pugh class B) complicated by hepatic hydrothorax, hepatic encephalopathy presented to the emergency department with right upper quadrant abdominal pain and jaundice. His medications included furosemide, lactulose, rifaximin, and spironolactone. The patient was found to have thrombocytopenia (platelet count < 65,000/mm3), cholestatic liver injury pattern, cholelithiasis and choledocholithiasis on MRCP.

 

The patient underwent ERCP with sphincterotomy and multiple small stone extractions. Significant post-sphincterotomy bleeding was noted, and complete hemostasis was achieved using a 10 mm x 60 mm fully covered metal biliary stent, bicap gold probe cautery, 4 mL of epinephrine 1/10000 dilution injection, and hemospray with bone wax. Due to the patient's history of cirrhosis and thrombocytopenia with concern for continued bleeding evidenced by melena, a repeat ERCP was performed. An ulceration with superficial oozing at the site of the sphincterotomy was then observed. Hemostasis was achieved by applying 3 mL of PuraStat gel to the ulcerated area. Purastat can be easily applied for post sphincterotomy bleeding using the sphincterotome. We describe this unique method of application in this report.

Discussion: To the best of our knowledge, this is the first case report emphasizing the application of Purastat through a sphincterotome for the management of post-sphincterotomy bleeding. The application of PuraStat as a hemostatic agent could potentially provide a valuable alternative or adjunct treatment option for addressing post-sphincterotomy bleeding. However, additional prospective studies are necessary to confirm the generalizability and efficacy of PuraStat gel in treating these patients


Disclosures:


Ahmed Ghanem, MD¹, Samuel Igbinedion, MD², Erik Holzwanger, MD³, Sultan Mahmood, MD³, Douglas Pleskow, MD, FACG⁴, Mandeep Sawhney, MD, MS³, Tyler Berzin, MD, FACG³, Moamen Gabr, MD, MSc,³. P0384 - Novel Hemostatic Agent as a Modality for Post-sphincterotomy Bleeding, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.