Post written by Shinya Kawaguchi, MD, from the Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan.

A bedridden woman with a history of repeated reflux esophagitis presented to the emergency department with a chief symptom of hematemesis. An urgent endoscopic examination was conducted. Insertion of a conventional endoscope (GIF-H290T; Olympus Corporation, Tokyo, Japan) revealed scar stenosis in the lower esophagus, making it difficult to pass the scope.

After switching to a small-diameter endoscope (GIF-1200N; Olympus), a diagnosis of hemorrhagic oozing because of Mallory-Weiss syndrome was made. The channel diameter of the scope used was 2.2 mm. Spraying thrombin did not resolve the oozing; thus, we decided to use a new self-assembling peptide matrix (PuraStat; 3-D Matrix, Tokyo, Japan).

Instead of the large-diameter dedicated tube, the metal part at the tip of the spraying tube (PW-6P-1; Olympus) (applicable channel diameter of 2.0 mm) was cut off, the stylet was removed, and the side opening of the tube was covered and locked. The PuraStat drug solution was administered to the bleeding region with a syringe. The hemostatic procedure was successful. Complete hemostasis and laceration healing were achieved, and the clinical course postprocedure was excellent.

Small-diameter endoscopes have a limited array of hemostatic equipment, making them less versatile in the management of acute GI bleeding. Recently, the PuraStat was approved for use as a hemostatic agent in GI endoscopic procedures. However, its dedicated tube diameter of 2.5 mm (applicable channel diameter of 2.8 mm) makes it impossible to use as-is.

This study may present a new method of upper GI hemostasis for pediatric GI endoscopists, including for infants who can pass only a small-diameter endoscope.

The tubes used for achieving hemostasis in this case (PW-6P-1; Olympus Corporation). The metal part at the tip of the spraying tube was cut off, the stylet was removed, the gutter of the tube was locked, and the PuraStat drug solution was administered with a syringe.

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