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

Lorenzo-Zúñiga, Vicente; Vega, Vicente Moreno de; Bartolı́, Ramón; Marín, Íngrid; Caballero, Noemí; Bon, Ignacio; Boix, Jaume

doi:10.4253/wjge.v10.i11.348

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…For instance, cold snare polypectomy is associated with an almost zero risk of post-procedure bleeding, yet not all large polyps may be resectable with a cold snare, and a greater risk of recurrence is a concern [24]. Other bleeding prevention methods are being investigated, including application of hemospray to the resection site (NCT01368731) or using a platelet-rich plasma for submucosal injection [25].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps

et al. 2020

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Background. Delayed bleeding is a common adverse event following endoscopic mucosal resection (EMR) of large colorectal polyps. Prophylactic clip closure of the mucosal defect after EMR of ≥20 mm non-pedunculated polyps reduces the incidence of severe delayed bleeding, especially in proximal polyps. Aim: Evaluate factors associated with complete prophylactic clip closure of the mucosal defect after EMR of large polyps. Methods: This is a post-hoc analysis of the CLIP STUDY (NCT01936948). All patients randomized to the clip group were included. Main outcome was complete clip closure of the mucosal resection defect. The defect was considered completely closed when there was no remaining visible mucosal defect and clips were <1cm apart. Factors associated with complete closure were evaluated in multivariable analysis. Results: 458 patients (age 65, 58% men) with 494 large polyps were included. Complete clip closure of the resection defect was achieved for 338 polyps (68.4%) and was not complete for 156 (31.6%). Factors associated with complete closure in adjusted analysis were smaller polyp size (OR 1.06 for every mm decrease [1.02-1.08]), good access (OR 3.58 [1.94-9.59]), complete submucosal lifting (OR 2.28 [1.36-3.90]), en bloc resection (OR 5.75 [1.48-22.39]), and serrated histology (OR 2.74 [1.35-5.56]). Conclusions: Complete clip closure was not achieved for almost 1 out of 3 resected large non-pedunculated polyps. While stable access and en bloc resection facilitate clip closure, most factors associated with clip closure are not modifiable and highlight the need for alternative closure options and preventative bleeding measures.

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Section: Discussionmentioning

confidence: 99%

Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps

et al. 2020

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“…Platelet-rich plasma (PRP), also known as autologous platelet gel, has demonstrated efficacy as submucosal injection before endoscopic mucosal resection of LNPCLs2 or local injection after endoscopic submucosal dissection 3. Shielding technique with PRP has proven favorable biological activities in preclinical endoscopic resection models 4…”

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confidence: 99%

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

Lorenzo-Zúñiga

Vega

Bartolı́³

2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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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.

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Dynamic functional clot formation in patients undergoing endoscopic mucosal resection

Froessler

Aboustate

et al. 2020

JGH Open

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Background and Aim Electric burns can induce fibrinolytic activity. Endoscopic mucosal resection (EMR) is a minimally invasive technique utilizing electrocautery for resection of dysplastic lesions from the gastrointestinal tract. EMR's main complication is clinically significant postendoscopic bleeding. Currently, no studies have investigated the impact of electrocautery during EMR on the coagulation cascade by viscoelastic hemostatic assay. Methods Thrombelastometry was performed and plasminogen levels were measured on blood samples taken prior to EMR, within an hour following the procedure and 2 days post‐EMR. Data were natural log‐transformed and analyzed using repeated‐measure analysis of covariance (ANCOVA) accounting for age, sex, body mass index (BMI) and site of EMR. Results Plasminogen levels decreased post‐EMR ( P = 0.001) and then increased 2 days post‐EMR ( P < 0.018). FIBTEM A10 and Maximum Clot Firmness, and EXTEM maximum lysis decreased an hour following EMR ( P < 0.05 for all). These three measurements then increased 2 days post‐EMR ( P < 0.01 for all). There were no significant differences in thrombelastometry or plasminogen measures according to sex, age, BMI, or site of EMR. One patient experienced clinically significant postendoscopic bleeding at one‐week post‐EMR, with substantially decreased FIBTEM A10 and Maximum Clot Firmness at 2 days post‐EMR. Conclusions Decreased post‐EMR plasminogen corresponds with reduced clot firmness and enhanced lysis affecting clot quality, strength, and stability. While further investigation in a larger sample is required to confirm the overall risk of clinically significant postendoscopic bleeding and mechanisms for plasminogen activation; this study highlights the potential utility of thrombelastometry in assessing fibrinolytic activity during EMR.

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

Cited by 4 publications

References 14 publications

Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps

Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps

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

Dynamic functional clot formation in patients undergoing endoscopic mucosal resection

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