Potential role of a synthetic peptide hydrogel in accelerating mucosal defect healing: evidence from a porcine model

The increasing use of advanced endoscopic resection techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), brings significant post-procedural challenges, particularly delayed bleeding and impaired wound healing. This study aimed to evaluate the efficacy of PuraStat, a synthetic peptide hydrogel, in promoting mucosal healing following endoscopic resections in the oesophagus and stomach of a porcine model.

In this prospective, randomised, evaluator-blinded preclinical study, 21 pigs underwent EMR and ESD in both the oesophagus and stomach (2 EMR and 2 ESD per animal). Animals were randomised to receive either PuraStat or saline on each resection site. Healing was evaluated after 8 days using follow-up endoscopy, gross pathology, and histopathological analysis. The primary endpoint was re-epithelialisation-to-defect ratio; secondary outcomes included macroscopic wound size reduction and granulation tissue characteristics.

A total of 84 lesions were assessed. Lesions treated with PuraStat demonstrated significantly greater re-epithelialisation/defect ratios compared to controls (p = 0.03), particularly after EMR. Endoscopic evaluation demonstrated a 33% mean reduction in wound size in the PuraStat group (p = 0.001). However, as endoscopic measurements carry an estimated error margin of up to ± 10%, its precision may be limited. Histopathological analysis of post-resection defect area reduction did not show statistically significant difference between groups (p = 0.055). No adverse events were observed, and PuraStat was well tolerated.

Application of PuraStat hydrogel after endoscopic resections was associated with improved re-epithelialisation, particularly in EMR-induced lesions. These findings indicate potential role of PuraStat in support of healing of mucosal post-resection defects in upper gastrointestinal tract, warranting its further validation in clinical trials.