A self-assembling matrix-forming gel can be easily and safely applied to prevent delayed bleeding after endoscopic resections.
BACKGROUND
Endoscopic resections have low morbidity and mortality. Delayed bleeding has been reported in approximately 1 - 15 % of cases, increasing with antiplatelet/anticoagulant therapy or portal hypertension. A self-assembling peptide (SAP) forming a gel could protect the mucosal defect during early healing. This retrospective trial aimed to assess the safety and efficacy of SAP in preventing delayed bleeding after endoscopic resections.


METHODS
Consecutive patients with endoscopic resections were enrolled in two tertiary referral centers. Patients with a high risk of bleeding (antiplatelet agents, anticoagulation drugs with heparin bridge therapy, and cirrhosis with portal hypertension) were also included. The SAP gel was applied immediately after resection to cover the whole ulcer bed.


RESULTS
In total, 56 patients were included with 65 lesions (esophagus [n = 8], stomach [n = 22], duodenum [n = 10], ampullary [n = 3], colon [n = 7], and rectum [n = 15]) in two centers. Among those 65 lesions, 29 were resected in high risk situations (9 uninterrupted aspirin therapy, 6 heparin bridge therapies, 5 cirrhosis and portal hypertension, 1 both cirrhosis and heparin bridge, 3 both cirrhosis and uninterrupted aspirin, 3 large duodenal lesions > 2 cm, and 2 early introduction of clopidogrel at day 1). The resection technique was endoscopic submucosal dissection (ESD) in 40 cases, en bloc endoscopic mucosal resection (EMR) in 16, piecemeal EMR in 6, and ampullectomy in 3. The mean lesion size was 37.9 mm (SD: 2.2 mm) with a mean area of 6.3 cm(2) (SD: 3.5 cm(2)). No difficulty was noted during application. Four delayed overt bleedings occurred (6.2 %) (3 hematochezia, 1 hematemesis) requiring endoscopic hemostasis. The mean hemoglobin drop off was 0.6 g/dL (- 0.6 to 3.1 g/dL). No adverse events occurred.


CONCLUSIONS
The use of this novel extracellular matrix scaffold may help to reduce post-endoscopic resection bleedings including in high risk situations. Its use is easy and safe but further comparative studies are warranted to completely evaluate its effectiveness.
Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France; INSERM U1032, Lyon, France; University Claude Bernard Lyon 1, Lyon, France.
Mathieu
M
Pioche
Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France; University Paris V Descartes, Paris, France.
Marine
M
Camus
Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France.
Jérôme
J
Rivory
Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France.
Sarah
S
Leblanc
Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France.
Isabelle
I
Lienhart
Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France; University Paris V Descartes, Paris, France.
Maximilien
M
Barret
Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France; University Paris V Descartes, Paris, France.
Stanislas
S
Chaussade
Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France; University Claude Bernard Lyon 1, Lyon, France.
Jean-Christophe
JC
Saurin
Endoscopy and Gastroenterology Unit, Assistance Publique Hôpitaux de Paris (APHP) Cochin Hospital, Paris, France; University Paris V Descartes, Paris, France.
Frederic
F
Prat
Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France; INSERM U1032, Lyon, France; University Claude Bernard Lyon 1, Lyon, France.
Thierry
T
Ponchon