Toshio Uraoka, MD, PhD, from the Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, in Tokyo, Japan discusses this New Methods article, “A novel fully synthetic and self-assembled peptide solution for endoscopic submucosal dissection-induced ulcer in the stomach.”

Application of a novel fully-synthetic and self-assembled peptide solution, which functions as an extracellular matrix scaffold material to facilitate healing of endoscopic submucosal dissection (ESD)-induced ulcers, appears to lower post-ESD bleeding rates, and higher healing and scarring rate.

Endoscopic submucosal dissection (ESD) can remove varying size early stage gastrointestinal tumors en bloc, however, success requires reducing a relatively high post-procedure bleeding rate. Gastric ESD-induced ulcers are also treated with proton pump inhibitors (PPIs) for at least 8 weeks in most hospitals, it does not eliminate the risk of bleeding.

Figure 1. Transition of gastric ESD-induced ulcers in the gastric angle after ESD. A, An early stage cancer on the posterior of the gastric angle. B, Endoscopic image after acetic acid and indigo-carmine dye spay. C, ESD-induced ulcer immediately after ESD. D, Application of PuraMatrix. E, One week after ESD, the ulcer was at the healing stage according to the Sakita and Fukutomi classification. F, At 4 weeks, the scarring stage was observed. G, At 8 weeks, the scarring stage was observed.

The application of a novel fully-synthetic and self-assembled peptide solution demonstrated its ability to reduce delayed bleeding rate and promote mucosal regeneration and speed of ulcer healing after gastric ESDs. There was no adverse effect related with this peptide solution in our trial. The advantages of this novel solution for endoscopic resection-induced ulcers are as follows:

• functions as an extracellar matrix scaffold material to replace collagen, tissue engineering and regenerative substances;
• no risk of infection because it is a fully-synthetic solution;
• a transparent aqueous solution that rapidly forms into a hydrogel in the body at physiologic pH; and
• an aqueous solution with easy application through a catheter from a prefilled syringe.

Further studies, multicenter, randomized controlled trials should be seriously considered to fully evaluate the efficacy of this novel peptide solution.

Find the abstract for this article here.

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