Endoscopic Shielding With Platelet-rich Plasma After Resection Of Large Colorectal Lesions

Abstract

Background: Platelet-rich plasma (PRP) has demonstrated efficacy as submucosal injection before endoscopic mucosal resection or local injection after endoscopic submucosal dissection of nonpedunculated colorectal lesions.Methods: The EndoPRP study was a prospective single-center study to analyze the efficacy of PRP shield after endoscopic mucosal resection of large nonpedunculated colorectal lesio with impossible clip closure, assessed by the incidence of delayed bleeding (DB) and delayed perforation, and percentage of mucosal restoration after 4 weeks (mucosal healing rate).Results: Shielding technique with PRP was performed in 4 patients, aged 52 to 80, with 4 lesions at rectum (mean size 53.7 ± 20.6 mm, range 35 to 80 mm). DB occurred in 1 lesion (25% of all lesions), no required blood transfusion or endoscopic treatment. No postoperative delayed perforation occurred. Mucosal healing rate was of 78.6% after 4 weeks.Conclusions: PRP shield failed in prevent DB, probably due to migration and failure in the adherence in large wounds. Future comparative studies are needed to confirm these data.

Preventing Postendoscopic Mucosal Resection Bleeding of Large Nonpedunculated Colorectal Lesions

“…As clips are not completely effective and cannot be used in at least one-third of mucosal defects, the effectiveness of other mechanical alternatives, such as combinations with larger clips and the use of loops, sutures, or other closing devices, must be tested. Coverage agents are already applied in some cases (61)(62)(63)66). However, we need to understand their efficacy and the context in which they should be used.…”

“…Their simple application may make them an ideal candidate for sole primary prophylaxis or in combination with clips in partial closures. The potential to promote wound healing insists that novel research avenues should be explored (64,66).…”

“…Different applied agents, such as the self-assembling peptide RADA16 (PuraStat 3D-Matrix, UK) (61–64), modified cyanoacrylate glue (N-butyl-2-cyanoacrylate + methacryloxysulfolane; Glubran 2, General Enterprise Marketing, Italy) (65), and platelet-rich plasma (66), have been evaluated in the prevention of bleeding after EMR (Table 3). RADA16, the only commercial agent in use, is a transparent, synthetic, self-assembling peptide hemostatic gel that works by forming a hydrogel matrix scaffold on the tissue surface.…”

Response to: Endoscopic Shielding With Platelet-rich Plasma After Resection of Large Colorectal Lesions

“…We read with great interest the Letter replying to our original article entitled "Endoscopic shielding with platelet-rich plasma after resection of large colorectal lesions" 1 and we would like to make some comments regarding their considerations.…”

Endoscopic Shielding With Platelet-rich Plasma After Resection of Large Colorectal Lesions: Stroma Microanatomy Raises Oncological Safety Issues

“…We read with great interest the article entitled "Endoscopic shielding with platelet-rich plasma after resection of large colorectal lesions" by Lorenzo-Zúñiga et al 1 This study aimed to investigate the effectiveness of platelet-rich plasma (PRP) application in enhancing healing after resection of large colorectal lesions. But can we consider PRP as a potentially safe concentrate that could be applied without concern after any intestinal excision?…”