Use of a Novel Self-assembling Peptide Gel for Prevention of Bleeding After Endoscopic Mucosal Resection of Large...

Endoscopic mucosal resection (EMR) of large nonpedunculated colorectal lesions (LNPCLs) carries a risk of delayed bleeding. To prevent this, the EMR defect can be clipped closed. However, this is often not possible with larger defects. Recently, a self-assembling peptide gel has become available, which may reduce delayed bleeding by creating a liquid bandage. There are limited data on the effectiveness of this agent. The aim of this study was to evaluate the gel for the prevention of delayed bleeding.

This is a multicenter retrospective case-control study from February 2019-February 2024 of consecutive patients undergoing EMR of LNPCLs not amenable to closure. Cases were patients with gel applied post EMR for prevention of bleeding vs controls without gel application. The primary outcome was the rate of gastrointestinal bleeding postprocedure.

A total of 176 patients were enrolled from 6 centers; of which, 94 lesions were cases and 91 were controls. The groups were statistically equivalent for bleeding risk factors. Postprocedural bleeding occurred in 11 cases vs 3 controls (12% vs 3%; P = .03). Bleeding occurred within 48 hours in 4 cases vs 3 controls (4% vs 3%; P = .7). Bleeding occurred between 48 hours and 2 weeks in 7 cases vs 0 controls (8% vs 0%; P = .008). On multivariate analysis, the odds ratio of bleeding was 4.95 (95% confidence interval: 1.17-21.91) with use of the gel.

Use of a novel self-assembling peptide gel after EMR of LNPCLs was associated with delayed bleeding. This observation needs to be validated in a prospective study.