Efficacy of platelet-rich plasma as a shielding technique after endoscopic mucosal resection in rat and porcine models

Abstract

Background and study aims: The aims were to assess the efficacy of endoscopic application of Platelet-rich plasma (PRP) to prevent delayed perforation and to induce mucosal healing after endoscopic resections. Patients and methods: Colonic induced lesions were performed in rats (n = 16) and pigs (n = 4). Animals were randomized to receive onto the lesions saline (control) or PRP. Animals underwent endoscopic follow-up. Thermal injury was assessed with a 1 – 4 scale: (1) mucosal necrosis; (2) submucosal necrosis; (3) muscularis propria necrosis; and (4) serosal necrosis Results: Saline treatment showed 50 % of mortality in rats (P = 0.02). Mean ulcerated area after 48 hours and 7 days was significantly smaller with PRP than with saline (0.27 ± 0.02 cm2 and 0.08 ± 0.01 cm2 vs. 0.56 ± 0.1 cm2 and 0.40 ± 0.06 cm2; P < 0.001). The incidence of thermal injury was significantly lower with PRP (1.25 ± 0.46) than in controls (2.25 ± 0.50); P = 0.006. The porcine model showed a trend toward higher mucosal restoration in animals treated with PRP than with saline at weeks 1 and 2 (Median area in cm2: 0.55 and 0.40 vs. 1.32 and 0.79) Conclusions: Application of PRP to colonic mucosal lesions showed strong healing properties in rat and porcine models.

Risk Factors for Delayed Ulcer Healing after Endoscopic Submucosal Dissection of Gastric Neoplasms

“…Such evidence would be useful for the treatment of large artificial ulcers or artificial ulcers in the lower third of the stomach. Shielding using platelet rich plasma (PRP) has also been shown to be effective in significantly reducing the size of EMR-induced ulcers of the colon in both rats and pigs (2.4% reduction in the control group versus 80% in treated animals) [27]. However, to our knowledge, there are no clinical reports on the use of PRP for the treatment of ulcers post-ESD.…”

Endoscopic shielding technique with a newly developed hydrogel to prevent thermal injury in two experimental models

“…In this sense, sealing mucosal lesions with endoscopic applied chitosan hydrogel containing epidermal growth factor induced both, a significant reduction in mucosal resection‐induced gastric ulcers in rabbits and pigs, and the appearance of deep scar formation and fibrotic submucosa in untreated lesions . More recently, our group has assessed the utility of platelet‐rich plasma applied onto colonic‐induced lesions, showing strong healing properties in preclinical studies …”

“…Until now, we do not have any valid endoscopic treatment to prevent this delayed complication; therefore, new methods are needed. In this sense, our group has proposed that endoscopic shielding technique (EndoSTech) is a new and easy way to manage lesions resulting from therapeutic endoscopy . As an important unmet topic in this field, we have developed a new topical composition, applied as a shield, to prevent CS.…”

Submucosal injection of platelet-rich plasma in endoscopic resection of large sessile lesions

“…The rationale for use PRP as solution to perform submucosal injection in endoscopic resection techniques lies in the exponential release of multiple bioactive factors, and subsequently, enhances the natural healing process, as well as in its haemostatic properties, with very low risk of fibrotic healing or strictures. In gastrointestinal disorders PRP has demonstrated efficacy in the prevention of DP[ 7 ] and wound healing in primary colonic anastomosis[ 12 ]. Previous reports have confirmed that surgical sites enhanced with PRP heal at rates two to three times those of untreated surgical sites and anabolic effects are directly correlated to platelet number[ 13 ].…”

“…The optimal fluid to lift the lesion is still a matter of debate. Platelet-rich plasma (PRP), as autologous concentrated in plasma, has demonstrated strong healing properties as a shield over the eschars after EMR in preclinical models[ 6 , 7 ]. PRP solution has showed the best electrical and rheological properties to perform safety endoscopic resections[ 8 ].…”