Self-assembling peptide hydrogel prevents esophageal stenosis after endoscopic submucosal dissection for esophageal squamous cell carcinoma: Multicenter prospective study

Yuji Urabe; Yuichi Hiyama; Naoki Asayama; Yuzuru Tamaru; Yoji Sanomura; Shigeto Yoshida; Shinji Nagata; Yuko Hiraga; Ayako Takamori; Yasushi Orihashi; Toshio Kuwai; Shiro Oka

doi:10.1055/a-2816-5350

Self-assembling peptide hydrogel prevents esophageal stenosis after endoscopic submucosal dissection for esophageal squamous cell carcinoma: Multicenter prospective study

Endosc Int Open. 2026 Mar 25:14:a28165350. doi: 10.1055/a-2816-5350. eCollection 2026.

Authors

Yuji Urabe¹, Yuichi Hiyama¹, Naoki Asayama², Yuzuru Tamaru³, Yoji Sanomura⁴, Shigeto Yoshida³, Shinji Nagata⁵, Yuko Hiraga⁴, Ayako Takamori⁶, Yasushi Orihashi⁶, Toshio Kuwai⁷, Shiro Oka⁸

Affiliations

¹ Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan.
² Gastroenterology, Hiroshima City North Medical Center, Asa Citizens Hospital, Hiroshima, Japan.
³ Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
⁴ Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan.
⁵ Department of Endoscopy, Hiroshima City North Medical Center, Asa Citizens Hospital, Hiroshima, Japan.
⁶ Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan.
⁷ Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan.
⁸ Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.

Abstract

Background and study aims: Self-assembling peptide hydrogel (PuraStat) is a novel self-assembling peptide-based hemostatic agent that forms a transparent hydrogel upon contact with blood or bodily fluids. It has been reported to reduce the number of coagulations required with hemostatic forceps during gastrointestinal endoscopic procedures. In addition to its hemostatic effect, recent studies have suggested that PuraStat promotes wound healing. This study aimed to investigate the efficacy of PuraStat in preventing esophageal stenosis following endoscopic treatment of esophageal squamous cell carcinoma (ESCC).

Patients and methods: This was a single-arm, multicenter, prospective study. Patients with esophageal squamous cell carcinoma who underwent endoscopic submucosal dissection and had a post-resection ulcer involving three-quarters or more of the full circumference of the esophagus received PuraStat application twice: once immediately after the procedure and once at second-look endoscopy 2 to 4 days later. The primary endpoint was incidence of esophageal stenosis within 12 weeks after endoscopic submucosal dissection. Secondary endpoints included the number of endoscopic balloon dilation procedures required and incidence of adverse events (AEs) and serious AEs.

Results: Twenty patients were enrolled, all of whom received PuraStat application. Incidence of esophageal stenosis within 12 weeks was 20% (4/20). All cases of stenosis resolved with fewer than six endoscopic balloon dilation procedures and no patients developed refractory esophageal stenosis. AEs were observed in four patients; however, all resolved with conservative management.

Conclusions: PuraStat application for post-endoscopic submucosal dissection ulcers in patients with ESCC may be useful for preventing esophageal stenosis.

Keywords: Benign strictures; Dilation, injection, stenting; Endoscopic resection (ESD, EMRc, ...); Endoscopic ultrasonography; Endoscopy Upper GI Tract; Esophageal cancer.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).