P2178 - Novel Hemostatic Gel Used in Bleeding Esophageal Ulcer Promotes Mucosal Healing

Rita Rehana, MD¹, Mohammed Barawi, MD^2
1Ascension Macomb-Oakland Hospital, Royal Oak, MI; ²Ascension St. John Hospital, Detroit, MI

Introduction: Intraprocedural bleeding during endoscopic intervention, gastrointestinal bleeding, or bleeding tumors can be treated with many different modalities such as heat therapy, endo-clipping, or embolization. One alternative option that has been proven in literature to be safe and effective is PuraStat, which is a novel self-assembling peptide used for hemostasis during endoscopic procedures such as polypectomies, submucosal dissection, and mucosal resection. This matrix-forming gel can be easily and safely applied to prevent delayed bleeding, accomplish hemostasis and effectively promote mucosal healing. Our case represents a patient who presented with active upper gastrointestinal bleeding that achieved hemostasis and wound healing with the use of PuraStat.

Case Description/Methods: We present an 86-year-old woman with no significant past medical history who presented with complaints of hematemesis. Vitals were stable and hemoglobin was 11.5 gm/dL. The patient was placed on high dose proton pump inhibitor therapy twice daily. The patient was taken for endoscopy within 24 hours of presentation. The scope revealed a 4 cm linear mid-esophageal ulceration with a large adherent clot. The clot was carefully removed using a cold snare and was cleared past the gastroesophageal junction. After re-examination, the area was noted to have active oozing. The bleed was treated using only PuraStat gel. It was applied by injection topically over the ulceration covering it entirely. The technique using the 25g needle allowed for accuracy and precision during application of the gel, allowing a thin layer to cover the esophageal ulcer. Inspection of ulceration shortly after the PuraStat application showed good hemostasis. Repeat endoscopy performed 2 days later due to drop in hemoglobin showed a clean based linear ulceration without active oozing or bleeding.

Discussion: Our case represents a patient who presented with an active upper gastrointestinal bleed which achieved hemostasis and subsequent wound healing with the use of a single hemostatic technique. This case demonstrated the matrix forming gel can be easily and safely applied with precision while using a 25g needle tip to prevent delayed bleeding, accomplish hemostasis, and promote wound healing.



Disclosures:


Rita Rehana, MD¹, Mohammed Barawi, MD². P2178 - Novel Hemostatic Gel Used in Bleeding Esophageal Ulcer Promotes Mucosal Healing, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.