LAUSR

Self-assembling peptides (PuraStat; 3-D Matrix, Tokyo, Japan) are novel synthetic self-assembling peptides that are licensed for use as a hemostat [1]. The matrix forms an extracellular scaffold that is activated by the change in pH on contact with blood and generates a stable mechanical barrier over the bleeding site, thereby facilitating intrinsic in vivo hemostasis [2]. Self-assembling peptides are mainly used to induce hemostasis of oozing bleeding in endoscopic procedures [3]; their usefulness in colorectal diverticular bleeding has yet to be investigated. In this study, we report a case in which the combination of self-assembling peptide solution and endoscopic band ligation (EBL) were effective for endoscopic hemostasis of spurting bleeding from a colonic diverticulum (▶Video 1). The patient was a 66-year-old woman who had hypertension and a history of diverticular bleeding 20 years previously. She presented to our emergency room withmassive bloody stools, a hemoglobin of 104g/L, progressive anemia, and pallor, and underwent emergency colonoscopy. During this examination, we observed spurting bleeding from a diverticulum at the hepatic flexure (▶Fig. 1 a). We identified the diverticulum as the source of the bleeding in the red dichromatic imaging (RDI) mode and marked its vicinity with a clip. Next, 3mL of the self-assembling peptide solution was injected into the diverticulum using a dispersal tube (▶Fig. 1b). After the injection, the spurting bleeding gradually subsided and hemostasis was temporarily achieved (▶Fig. 1 c). We removed the scope, placed a band onto it, and reinserted it, with the diverticulum confirmed as the source of bleeding by locating the clip. Complete hemostasis was achieved via EBL (▶Fig. 1d).The patient resumed eating the day after hemostasis had been achieved and was discharged 5 days later without any evidence of further bleeding or progression of anemia. In this case, the self-assembling peptide solution temporarily stopped the spurting bleeding, making it easier to identify the bleeding point. Furthermore, the temporary hemostasis ensured a stable visual field, thereby permitting safe EBL to be performed.