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Article

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

by
Cecilia Binda
1,
Alessandro Fugazza
2,
Stefano Fabbri
1,
Chiara Coluccio
1,
Alessandro Repici
2,3,
Ilaria Tarantino
4,
Andrea Anderloni
5 and
Carlo Fabbri
1,*
1
AUSL Romagna, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Forlì-Cesena, Italy
2
Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, 20089 Milan, Italy
3
Humanitas University, Department of Biomedical Sciences, 20090 Pieve Emanuele, Italy
4
Digestive Endoscopy and Gastroenterology Unit, Department of Gastroenterology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IsMeTT/UPMC), 90127 Palermo, Italy
5
Fondazione I.R.C.C.S. Policlinico San Matteo, Gastroenterology and Digestive Endoscopy Unit, 27100 Pavia, Italy
*
Author to whom correspondence should be addressed.
Medicina 2023, 59(4), 750; https://doi.org/10.3390/medicina59040750
Submission received: 24 February 2023 / Revised: 10 April 2023 / Accepted: 11 April 2023 / Published: 12 April 2023
(This article belongs to the Special Issue Digestive Endoscopy: Inside the Evidence and Outside)
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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.
Keywords: PuraStat; walled-off pancreatic necrosis; pancreatic fluid collection; LAMS; EUS-guided drainage; bleeding; endoscopic hemostasis; endoscopic hemostatic agents PuraStat; walled-off pancreatic necrosis; pancreatic fluid collection; LAMS; EUS-guided drainage; bleeding; endoscopic hemostasis; endoscopic hemostatic agents

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MDPI and ACS Style

Binda, C.; Fugazza, A.; Fabbri, S.; Coluccio, C.; Repici, A.; Tarantino, I.; Anderloni, A.; Fabbri, C. The Use of PuraStat® in the Management of Walled-Off Pancreatic Necrosis Drained Using Lumen-Apposing Metal Stents: A Case Series. Medicina 2023, 59, 750. https://doi.org/10.3390/medicina59040750

AMA Style

Binda C, Fugazza A, Fabbri S, Coluccio C, Repici A, Tarantino I, Anderloni A, Fabbri C. The Use of PuraStat® in the Management of Walled-Off Pancreatic Necrosis Drained Using Lumen-Apposing Metal Stents: A Case Series. Medicina. 2023; 59(4):750. https://doi.org/10.3390/medicina59040750

Chicago/Turabian Style

Binda, Cecilia, Alessandro Fugazza, Stefano Fabbri, Chiara Coluccio, Alessandro Repici, Ilaria Tarantino, Andrea Anderloni, and Carlo Fabbri. 2023. "The Use of PuraStat® in the Management of Walled-Off Pancreatic Necrosis Drained Using Lumen-Apposing Metal Stents: A Case Series" Medicina 59, no. 4: 750. https://doi.org/10.3390/medicina59040750

APA Style

Binda, C., Fugazza, A., Fabbri, S., Coluccio, C., Repici, A., Tarantino, I., Anderloni, A., & Fabbri, C. (2023). The Use of PuraStat® in the Management of Walled-Off Pancreatic Necrosis Drained Using Lumen-Apposing Metal Stents: A Case Series. Medicina, 59(4), 750. https://doi.org/10.3390/medicina59040750

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