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Use of a novel self‐assembling hemostatic gel as a complementary therapeutic tool for endoscopic sphincterotomy‐related bleeding

Endoscopic sphincterotomy (EST)related bleeding is an endoscopic retrograde cholangiopancreatography (ERCP)related adverse event (AE) that requires emergency endoscopic hemostasis.1 When ESTrelated bleeding does not respond to traditional endoscopic interventions such as epinephrine injection, balloon tamponade, thermal cautery, or clip placement, a fully covered selfexpandable metal stent (FCSEMS) can be used to mechanically compress the bleeding site, thereby achieving hemostasis.2 However, the use of FCSEMS may not be costeffective and carries the risk of AEs such as pancreatitis and cholecystitis. PuraStat® (3D Matrix Europe SAS, Figure 1) is a novel selfassembling peptide hydrogel developed as a hemostatic agent for endoscopic and surgical procedures.3,4 Here, we report the effective use of this hemostatic gel as a complementary therapeutic tool for ESTrelated bleeding. A 79yearold man who had undergone Billroth II reconstruction after subtotal gastrectomy was admitted to our unit for treatment of choledocholithiasis. The patient had no history of antithrombotic medication. Bile duct stones were removed after EST under balloon enteroscopyassisted ERCP and a nasal biliary tube was placed. Two days later, he developed melena, suggesting ESTrelated bleeding. Endoscopic examination revealed a hemorrhage from the orifice