Successful hemostasis and subsequent cannulation using a self-assembling peptide hydrogel for bleeding after precut sphincterotomy.

Precut techniques, such as needle-knife sphincterotomy and transpancreatic sphincterotomy, are useful as salvage techniques for cases in which biliary cannulation is difficult [1]. If massive bleeding occurs during precutting, various methods may be used to achieve hemostasis, including epinephrine injection, thermal cautery, and clipping. However, all of the above may affect the duodenal papilla, complicating subsequent cannulation. Additionally, the coagulum and hematoma resulting from such an event obscure the papilla, which also impedes cannulation. A novel, self-assembling peptide hydrogel (PuraStat; 3-D Matrix, Tokyo, Japan) was recently developed as a hemostatic agent [2] [3] [4]. We present a case in which this hydrogel was useful for hemostasis and subsequent cannulation following massive bleeding during precut sphincterotomy.