Short abstract
Watch a video of this article.
Brief Explanation
Endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) is a very important and useful method in the clinical setting. Bleeding is one of a few adverse events for EUS‐TA. 1 Recently, a novel self‐assembling peptide hemostatic gel was reported to be safe and effective against bleeding. 2 , 3 , 4 , 5 We herein describe a case of endoscopic hemostasis for post‐EUS‐TA bleeding using a novel hemostatic gel.
The patient was a 66‐year‐old man. The biliary and pancreatic stents were inserted for obstructive jaundice at another hospital. Bile duct biopsies for the stenosis were performed at that time, not leading to a histological diagnosis of malignancy. Therefore, the patient was transferred to our hospital. The patient continued heparin after switching from warfarin. We visualized a hypoechoic mass (20 mm in diameter) in the pancreatic head in EUS and suspected pancreatic cancer. We performed EUS‐TA from the duodenal bulb using a 25G Franseen needle, because the intramural vessel and the gastroduodenal artery intervened on the puncture route (Video S1). Spurting hemorrhage was observed in the duodenal cavity after the puncture (Fig. 1). At first, we confirmed that there were no intraperitoneal and intramural bleeding by EUS. We then pressed the bleeding point with the EUS scope. After confirming that the bleeding was weakened to oozing, we sprayed 3 mL of a novel self‐assembling peptide hemostatic gel (PuraStat; 3‐D Matrix, Tokyo, Japan) and confirmed the hemostasis (Fig. 2).
Figure 1.
(a) Endoscopic ultrasound‐guided tissue acquisition was performed for a pancreatic tumor (white arrows) from the duodenal bulb using a 25G Franseen needle (white arrowhead). (b) There was no intraperitoneal or intramural bleeding (yellow arrowhead). (c) Spurting hemorrhage occurred from the puncture site (yellow arrow).
Figure 2.
(a) After pressing the bleeding point with the endoscopic ultrasound scope, the bleeding was weakened to oozing (yellow arrow); (b) a novel self‐assembling peptide hemostatic gel (PuraStat; 3‐D Matrix, Tokyo, Japan) was subsequently applied. (c) Hemostasis was successfully achieved.
For endoscopically visible bleeding without intramucosal bleeding, pressing the bleeding point with the EUS scope is useful. If the bleeding nevertheless does not subside, hemoclips may be needed. In such a situation, a novel self‐assembling peptide hemostatic gel can be an effective and safe option for hemostasis.
Authors declare no conflict of interest for this article.
INFORMED CONSENT
The subject of the case report provided informed consent to publish the included information.
Supporting information
Video S1 Novel hemostatic gel for post‐endoscopic ultrasound‐guided tissue acquisition bleeding.
REFERENCES
- 1. Kanno A, Yasuda I, Irisawa A et al. Adverse events of endoscopic ultrasound‐guided fine‐needle aspiration for histologic diagnosis in Japanese tertiary centers: Multicenter retrospective study. Dig Endosc 2021; 33: 1146–57. [DOI] [PubMed] [Google Scholar]
- 2. Kubo Y, Kobayashi S, Yamamoto K et al. Endoscopic application of novel, infection‐free, advanced hemostatic material: Its usefulness to upper gastrointestinal oozing. DEN Open 2022; 2: e25. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Yamamoto K, Sofuni A, Mukai S et al. Use of a novel self‐assembling hemostatic gel as a complementary therapeutic tool for endoscopic sphincterotomy‐related bleeding. J Hepatobiliary Pancreat Sci 2022; 29: E81–3. [DOI] [PubMed] [Google Scholar]
- 4. Miyano A, Ogura T, Nishikawa H. Noninvasive endoscopic hemostasis technique for post‐papillectomy bleeding using a novel self‐assembling peptide (with video). JGH Open 2023; 7: 81–2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Nakahara K, Sekine A, Tateishi K. Self‐assembling peptide gel application to achieve endoscopic hemostasis for fistula bleeding after lumen apposing metal stent removal. Dig Endosc 2023; 35: e48–9. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Video S1 Novel hemostatic gel for post‐endoscopic ultrasound‐guided tissue acquisition bleeding.