Enhancing visibility and hemostasis during necrosectomy for walled-off necrosis: the “dual-gel method”

Endoscopic necrosectomy is an effective treatment for walled-off necrosis (WON); however, bleeding complications can be life threatening and require an immediate response [1]. Blood accumulation within the WON compartment makes identifying bleeding blood vessels difficult. Furthermore, the use of clips for hemostasis increases the risk of leaving long-term remains within the WON. Recently, a method for maintaining visibility during gastrointestinal bleeding involving the injection of a gel with an appropriate viscosity (Viscoclear; Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan) was reported [2] [3]. Additionally, the hemostatic effect of a self-assembling peptide gel (PuraStat; 3-D Matrix Europe SAS, Lyon, France) used during gastrointestinal endoscopic procedures has been reported [4] [5]. Purastat is an aqueous peptide solution that becomes neutral upon contact with blood and body fluids, and its peptide molecules form fibers in solution to form a peptide hydrogel. This hydrogel quickly coats the bleeding point and stops the bleeding. In this case, we successfully employed a novel "dual-gel method" that uses Viscoclear and PuraStat to achieve hemostasis during endoscopic necrosectomy.