The Use of PuraStat® in the Management of Walled-Off Pancreatic Necrosis Drained Using Lumen-Apposing Metal Stents: A Case Series

Abstract

Background and Objectives: Bleeding is one of the most feared and frequent adverse events in the case of EUS-guided drainage of WOPN using lumen-apposing metal stents (LAMSs) and of direct endoscopic necrosectomy (DEN). When it occurs, its management is still controversial. In the last few years, PuraStat, a novel hemostatic peptide gel has been introduced, expanding the toolbox of the endoscopic hemostatic agents. The aim of this case series was to evaluate the safety and efficacy of PuraStat in preventing and controlling bleeding of WOPN drainage using LAMSs. Materials and Methods: This is a multicenter, retrospective pilot study from three high-volume centers in Italy, including all consecutive patients treated with the novel hemostatic peptide gel after LAMSs placement for the drainage of symptomatic WOPN between 2019 and 2022. Results: A total of 10 patients were included. All patients underwent at least one session of DEN. Technical success of PuraStat was achieved in 100% of patients. In seven cases PuraStat was placed for post-DEN bleeding prevention, with one patient experiencing bleeding after DEN. In three cases, on the other hand, PuraStat was placed to manage active bleeding: two cases of oozing were successfully controlled with gel application, and a massive spurting from a retroperitoneal vessel required subsequent angiography. No re-bleeding occurred. No PuraStat-related adverse events were reported. Conclusions: This novel peptide gel could represent a promising hemostatic device, both in preventing and managing active bleeding after EUS-guided drainage of WON. Further prospective studies are needed to confirm its efficacy.

Indications, Techniques and Future Perspectives of Walled-off Necrosis Management

“…The most common was bleeding (18%), followed by pancreatic fistula (5%) and perforation (4%). Endoscopic hemostasis within the necrotic cavity using hemostatic forceps, self-assembling peptide gel, spray coagulation, glue or clipping has been reported in small case series and case reports [72][73][74][75][76][77]. However, severe bleeding may require radiological intervention with embolization.…”

Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved

“…Binda et al [86] reported a case series of 10 patients treated with PuraStat ® (3-D Matrix Europe SAS, Caluire-et-Cuire, France), a novel hemostatic peptide gel, both prevention and management of PFC-related bleeding. Indeed, PuraStat can be easily and safely applied inside the cavity of the WOPN, is effective in treating oozing-type bleeding, and, thanks to its three-dimensional structure, might promote healing, preventing delayed bleeding.…”