Novel use of synthetic peptide hemostatic gel in conjunction with EUS-guided coil injection for the treatment of gastric varices: A single-center experience.

BACKGROUND AND OBJECTIVES: Bleeding from gastric varices (GV) is severe and associated with high mortality. The standard endoscopic therapy, EUS-guided coil injection with cyanoacrylate glue (EUS-COIL + glue), is highly effective but carries a risk of systemic embolization. This study investigates the safety and efficacy of PuraStat, a synthetic peptide hemostatic gel that promotes clot formation without embolization risk, as an alternative injectate in conjunction with EUS-COIL. METHODS: This was a single-center, retrospective analysis of 9 patients who underwent EUS-COIL + PuraStat for GV treatment (active bleeding, recent bleeding, or primary prophylaxis). Technical success was defined as successful coil deployment and reduction of Doppler flow; clinical success as bleeding cessation and/or absence of bleeding at 30 days. Secondary outcomes included adverse events (AEs) and re-intervention rates during follow-up. RESULTS: Technical and clinical success was achieved in 100% of the procedures. There were no intraprocedural AEs, and only 1 minor (Grade II) postprocedural AE was recorded (10%). No patients experienced systemic embolization. One patient (11%) experienced recurrent bleeding at 54 days. Over a mean follow-up of 289 days, 56% of patients required repeat EUS-COIL procedures. CONCLUSION: EUS-COIL with PuraStat is a safe and highly effective treatment for GV in this small cohort, demonstrating excellent immediate success without the risk of systemic embolization associated with cyanoacrylate glue. While its use may necessitate earlier and more frequent surveillance and re-intervention, its superior safety profile makes it an attractive option. Larger comparative studies are warranted.