Efficacy of a Hemostatic Agent (PuraStat®) in Reducing Delayed Bleeding After Endoscopic Submucosal Dissection

Last updated: February 20, 2024
Sponsor: Mathieu Pioche
Overall Status: Active - Recruiting

Phase

N/A

Condition

Hemorrhage

Treatment

Endoscopic submucosal dissection with Purastat

Clinical Study ID

NCT05031325
SFED 151
  • Ages 18-90
  • All Genders

Study Summary

The problem of delayed bleeding after endoscopic resection is becoming important due to the growing number of indications for anti-aggregation or anticoagulant treatment for cardiovascular reasons in the aging populations. Previous studies have shown that in patients at high risk of bleeding, the use of (PuraStat®), a simple and easily applicable solution, decreases the rate of delayed bleeding by promoting wound healing. Various preventive treatments, such as the prophylactic use of clips, have been tried to prevent the occurrence of delayed bleeding, but to date, no treatment has clearly shown its effectiveness. In addition, preventive hemostasis with clips is difficult and costly. The main objective is to compare the efficacy of PuraStat® to the standard treatment in reducing delayed bleeding after colorectal ESD in patients at high risk of delayed bleeding. The secondary objectives are to compare the same two strategies in terms of effectiveness and side effects. The primary outcome measure is the percentage of delayed bleeding at 30 days after surgery (ESD).

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patients of both sexes aged 18 years or older
  • Patient with a validated indication for colonoscopy for colorectal lesions
  • Patients with a single colorectal lesion to be resected by ESD according to Europeanrecommendations.
  • Patients with a colorectal neoplastic lesion (≥3 cm)
  • Patients taking anticoagulants (acetylsalicylic acid >300 mg/day) or antiplateletagents (clopidogrel, prasugrel, ticagrelor, clopidogrel) and managed according toEuropean recommendations for ESD (including patients who may require heparinreplacement)
  • Written consent signed after clear, fair, and understood information.
  • Patients with social security coverage.

Exclusion

Exclusion Criteria:

  • Patients who may have an allergic reaction to the substances of PuraStat®.
  • Patients with severe fibrosis
  • Patients with a history of familial colorectal polyposis (familial adenomatous, Lynchsyndrome, Peutz-Jeghers syndrome)
  • Patients with a score ASA greater than or equal to 4 or 5
  • Patients with a platelet count of 50,000/mm3
  • Patients with acquired (non-medicated) or inherited bleeding disorders
  • Patients who are being treated with acetylsalicylic acid but whose treatment isdiscontinued at the time of the procedure (therapeutic window)
  • Patients with advanced cancer or inflammatory bowel disease, including ulcerativecolitis (with colonic involvement)
  • Contraindication to general anesthesia
  • Patients with a mental disorder, drug addiction, alcoholism, etc.
  • Pregnant women or women wishing to become pregnant during the study
  • Patients already participating or scheduled to participate in other clinical trials
  • Lesion that has been previously resected by mucosectomy
  • Patient with an initial metastatic lesion prior to colonoscopy.
  • Patient unable to give personal consent
  • Lack of signed informed consent

Study Design

Total Participants: 288
Treatment Group(s): 1
Primary Treatment: Endoscopic submucosal dissection with Purastat
Phase:
Study Start date:
February 28, 2022
Estimated Completion Date:
December 26, 2024

Connect with a study center

  • Hopital Edouard Herriot

    Lyon,
    France

    Active - Recruiting

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