Clinical Endoscopy

Review

Post-polypectomy colorectal bleeding: current strategies and the way forward: Nilanga Nishad, Mo Hameed Thoufeeq; Received September 3, 2024 Accepted September 23, 2024 Published online November 27, 2024; DOI: https://doi.org/10.5946/ce.2024.241 [Epub ahead of print]

Abstract PDF PubReader ePub: Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding.

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Systematic Review and Meta-analysis

Systematic review of self-assembling peptides as topical agents for treatment and prevention of gastrointestinal bleeding: Andrei Voiosu, Monica State, Victor Drăgan, Sergiu Văduva, Paul Bălănescu, Radu Bogdan Mateescu, Theodor Voiosu; Clin Endosc 2024;57(4):454-465. Published online May 24, 2024; DOI: https://doi.org/10.5946/ce.2023.168

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Gastrointestinal bleeding is a significant and potentially lethal event. We aimed to review the efficiency and safety of self-assembling peptides for the treatment and prevention of gastrointestinal tract bleeding.
Methods
We conducted a systematic search for studies describing the endoscopic use of self-assembling peptides for treatment or prevention of bleeding in the gastrointestinal tract in a parallel, independent fashion. The primary outcomes were rates of successful initial hemostasis, delayed bleeding, and rebleeding. The secondary outcomes were adverse events and ease and volume of gel used.
Results
Seventeen studies were analyzed. Overall success rate of self-assembling peptides in gastrointestinal bleeding was 87.7% (38%–100%), regardless of etiology or associated treatments. Rebleeding rate ranged from 0% to 16.2%, with a mean of 4.7%, and overall delayed bleeding rate was 5% (range, 0%–15.9%). Only three adverse events were reported in a pooled number of 815 patients. The volume of gel used varied (0.43 to 3.7 mL) according to indication and type of bleeding.
Conclusions
The limited available data on the use of self-assembling peptides in gastrointestinal endoscopy suggest a high efficiency and good safety profile.

Citations

Citations to this article as recorded by

PuraStat as secondary therapy for hemostasis in Mallory−Weiss syndrome with oral antithrombotic medication
Makoto Higashino, Hidehiro Murakami, Tetsu Hirata, Hiroaki Miyaoka
DEN Open.2025;[Epub] CrossRef

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2 Web of Science
1 Crossref

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