Takeshi Ogura ,Yuki Uba,Masahiro Yamamura,Nobu Nishioka,Hiroki Nishikawa

2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan

TotheEditor:

Endoscopic sphincterotomy (EST) is an established technique for removal of bile duct stones and self-expandable metal stent(SEMS) deployment.However,bleeding can be considered an adverse event after EST,particularly for patients with high risk of bleeding such as those on hemodialysis.Among the various techniques reported for obtaining endoscopic hemostasis [1–3],SEMS deployment is useful in terms of its tamponade effect,but bleeding can occur continuously even following SEMS deployment from the upper edge of the ampulla of Vater.In this situation,coagulation or endoscopic injection of epinephrine can be considered,but this might be complicated by the presence of ulcer formation.A novel hemostatic agent (PuraStat?,3D Matrix Europe SAS,Caluireet-Cuire,France) has recently become available [4].Here we describe a case of successful endoscopic hemostasis using SEMS combined with PuraStat?in a patient with high risk of post-EST bleeding.

A 77-year-old female who was complicated with hemodialysis was admitted to our hospital for treatment of obstructive jaundice caused by pancreatic cancer,and biliary drainage was attempted using SEMS.EST performed after successful biliary cannulation was complicated by oozing (Fig.1).To obtain hemostasis and achieve biliary drainage,we attempted SEMS deployment,which was performed successfully (Fig.2).However,continuous oozing was observed from the upper edge of the SEMS (Fig.3),and we therefore applied PuraStat?at the oozing point using the dedicated delivery catheter (Fig.4,Video S1).After this procedure,hemostasis was obtained and there were no adverse events associated with PuraStat?application (Fig.5).

Fig.1. Oozing was observed during endoscopic sphincterotomy.

Fig.2. To obtain hemostasis,a self-expandable metal stent was successfully deployed.

Fig.3. Continuous oozing from the upper edge of the self-expandable metal stent.

Fig.4. PuraStat ? was applied at the oozing point.

Fig.5. Hemostasis was obtained.

PuraStat?application might be useful for hemostasis in the event of bleeding from the upper edge following SEMS deployment,particularly in patients with high risk of post-EST bleeding.

Acknowledgments

None.

CRediT authorship contribution statement

Takeshi Ogura:Conceptualization,Data curation,Writing-original draft.Yuki Uba:Writing-review &editing.Masahiro Ya-mamura:Writing-review &editing.Nobu Nishioka:Writing-review &editing.Hiroki Nishikawa:Writing-review &editing.

Funding

None.

Ethical approval

Written informed consent was obtained from the patient.

Competing interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Supplementary materials

Supplementary material associated with this article can be found,in the online version,at doi: 10.1016/j.hbpd.2023.02.001.