Endoscopic papillectomy (EP) is useful for treating ampullary neoplasms. Post‐procedural delayed bleeding is one of the most frequent adverse events [1, 2], and endoscopic hemostasis, such as clipping or cauterization, is recommended as first‐line therapy [1, 2]. Recently, a novel self‐assembling peptide matrix (PuraStat; 3‐D Matrix Europe SAS, France) was launched, which is approved for hemostasis in gastrointestinal endoscopic procedures [3, 4, 5]. Here, we describe a case of endoscopic hemostasis using this self‐assembling hemostatic agent for delayed bleeding after EP.
A 70‐year‐old woman with Glanzmann thrombasthenia presented with tarry stool and dizziness that had persisted for 2–3 days. This patient had a history of recurrent anemia caused by a hemorrhage from the ampulla of Vater. Endoscopic examination revealed a hemorrhage from ampullary telangiectasia (Figure 1a,b). Therefore, EP was performed to control bleeding. The ampulla of Vater was resected without complications (Figure 1c–e), and the resected specimen was diagnosed as having vascular ectasia (Figure 1f). Despite adequate platelet transfusion, the progression of anemia was observed for four consecutive days after the procedure. Endoscopic examination showed oozing bleeding from the resection surface of the ampulla of Vater (Figure 2a). The bleeding point was not identifiable under gel immersion, and the presence of a pancreatic stent and clip devices made it difficult to use hemostatic devices such as clips or cauterization. Therefore, endoscopic hemostasis was performed using a self‐assembling hemostatic agent (Video S1). First, 3 mL of the agent was applied to the bleeding point using an endoscopic catheter (Figure 2b). The flow of the bleeding weakened, but hemostasis was not achieved. Thus, an additional 3 mL of agent was applied, and complete hemostasis was achieved (Figure 2c). There were no procedure‐related adverse events, including rebleeding. This hemostatic agent was quite effective for controlling oozing bleeding in a patient with a platelet function disorder.
FIGURE 1.
Endoscopic papillectomy. (a, b) Endoscopic examination revealed a hemorrhage from ampullary telangiectasia. (c, d) The ampulla of Vater was resected without complications. (e) During the EP procedure, slight bleeding from the resection surface was observed, and hemostasis was achieved using a hemostatic agent. (f) The resected specimen showing vascular ectasia under mucosal and submucosal layer.
FIGURE 2.
Endoscopic hemostasis using a self‐assembling hemostatic agent. (a) Endoscopic examination revealed oozing bleeding from the resection surface of the ampulla of Vater. (b) The hemostatic agent was applied to the bleeding point using an endoscopic catheter. (c) Complete hemostasis was successfully achieved with no procedure‐related adverse events, including rebleeding.
Author Contributions
Conception and design: Noriyuki Hirakawa, Kenjiro Yamamoto, and Takao Itoi. Manuscript preparation: Noriyuki Hirakawa and Kenjiro Yamamoto. Endoscopic procedures: Noriyuki Hirakawa and Kenjiro Yamamoto.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Video S1: Endoscopic hemostasis by a self‐assembling hemostatic agent for post‐endoscopic papillectomy delayed bleeding.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Video S1: Endoscopic hemostasis by a self‐assembling hemostatic agent for post‐endoscopic papillectomy delayed bleeding.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.