Efficacy of platelet-rich plasma as a shielding technique after endoscopic mucosal resection in rat and porcine models

Prevention of late complications with coverage agents in endoscopic resection of colorectal lesions: Current landscape in gastrointestinal endoscopy

Endoscopic removal of large (≥ 20 mm) non-pedunculated colorectal lesions (LNPCLs) may result in major adverse events, such as delayed bleeding (DB) and delayed perforation (DP), despite closure of the mucosal defects with clips. Topical application of a coverage agent refers to the creation of a shield with a biocompatible medical device (tissue or hydrogel) with proven bioactive properties. Coverage of the eschar after endoscopic resection provides shielding protection to prevent delayed complications. The aim of the present review was to systematically collect and review the currently available literature regarding the prevention of DB and DP with coverage agents after endoscopic mucosal resection or endoscopic submucosal dissection of LNPCLs.

Effectiveness of Autologous Platelet-Rich Plasma for the Healing of Ulcers after Endoscopic Submucosal Dissection

Background/Aims

Platelet-rich plasma (PRP) has been used for wound healing in various medical fields. The aim of this study was to evaluate the clinical efficacy and safety of local PRP injections after endoscopic submucosal dissection (ESD).

Methods

Patients were non-randomly divided into the following two groups: (1) control group in which patients were administered only an intravenous proton pump inhibitor (PPI), and (2) a study group in which patients were administered an intravenous PPI and a topical PRP injection. We assessed the reduction in the ulcer area and stage of the ulcer after the procedure (24 hours, 48 hours, and 28 days after endoscopic surgery).

Results

We enrolled 7 study and 7 control patients. In the study group, the rate of ulcer reduction was 59% compared to 52% in the control group (p=0.372), 28 days after ESD. There were 5 patients in the S stage and 2 patients in the H stage in the study group compared to no patient in the S stage and 7 patients in the H stage in the control group (p=0.05), 28 days after ESD. There were no serious complications in either group.

Conclusions

The local injection of PRP is a safe and effective procedure for ulcer healing after ESD.

Submucosal injection of platelet-rich plasma in endoscopic resection of large sessile lesions

AIM

To prospectively evaluate the efficacy of submucosal injection of platelet-rich plasma (PRP) on endoscopic resection of large sessile lesions.

METHODS

Eleven patients were submitted to endoscopic mucosal resection (EMR) with prior injection of PRP, obtained at the time of endoscopy. Patients were followed during 1 mo. The incidence of adverse events (delayed bleeding or perforation) and the percentage of mucosal healing (MHR) after 4 wk were registered.

RESULTS

EMR was performed in 11 lesions (46.4 mm ± 4 mm, range 40-70 mm). Delayed bleeding or perforation was not observed in any patient. Mean ulcerated area at baseline was 22.7 cm2 ± 11.7 cm2 whereas at week 4 were 2.9 cm2 ± 1.5 cm2. Patients treated with PRP showed a very high MHR after 4 wk (87.5%).

CONCLUSION

PRP is an easy-to-obtain solution with proven and favourable biological activities that could be used in advanced endoscopic resection.

Endoscopic shielding technique, a new method in therapeutic endoscopy

Prevention of late complications after large endoscopic resection is inefficient with current methods. Endoscopic shielding, as a simple and safe technique, has been proposed to improve the incidence of these events. Different methods, sheets or hydrogels, have showed proven efficacy in the prevention of late bleeding and perforation, as well as the improvement of tissue repair, in experimental models and in clinical practice.