Difficult arterial bleeding during gastric ESD: self-assembling peptide gel saves the day!

Abstract Text We performed ESD for a 4-cm early gastric cancer Paris type IIa+c lesion located on the lesser curvature in a 77 year-old man. He was cardiostimulated for atrial fibrillation and received the last dose of low molecular weight heparin 12 hours prior. Halfway through dissection with the IT2-knife an important arterial bleeding occurred while injection and coagulation by coagrasper failed. In order to finish the procedure, we opted for application of self-assembling peptide gel with which the hemostasis was achieved. We continued dissection in another region and finished the resection by cutting through the transparent gel with no intraprocedural recurrence of the bleeding. Pathology confirmed R0 resection of a G1 intestinal-type adenocarcinoma eCura A and no recurrence was seen at follow-up. The case illustrates a procedure-rescuing use of hemostatic gel, allowing optimal patient outcome.

Publication History

Article published online:
15 April 2024