# A clear approach: Hemostatic gel as a novel adjunct for pediatric upper gastrointestinal bleeding

## TL;DR

This paper explores the use of a clear hemostatic gel, PuraStat®, in treating pediatric upper gastrointestinal bleeding, showing it is easy to use and well-tolerated.

## Contribution

The study presents the first documented use of PuraStat® as an adjunct in pediatric upper gastrointestinal bleeding cases.

## Key findings

- PuraStat® was well-tolerated and appeared beneficial in four pediatric cases of upper gastrointestinal bleeding.
- The gel preserved endoscopic visibility, overcoming a limitation of hemostatic powders.
- It was used as an adjunct or monotherapy, suggesting potential as a promising treatment option.

## Abstract

Pediatric upper gastrointestinal bleeding (UGIB) is a significant clinical concern, with a mortality rate of approximately 2%. Endoscopic management of UGIB in children includes various techniques such as injections, mechanical devices, thermal therapies, and topical agents. PuraStat®, a clear hemostatic gel, has been used in adults to create a physical barrier for hemostasis without obscuring the endoscopic view. However, its use in pediatric UGIB has not been well‐documented. A review of four pediatric cases where PuraStat® was used to treat UGIB showed that it was applied as an adjunct to other hemostatic methods like clip placement or epinephrine injections, and in one case, as monotherapy for a large duodenal ulcer/site of recently contained perforation. The gel was easy to use, appeared to be beneficial, and was well‐tolerated in this small cohort, although conclusions regarding its safety and efficacy are limited by the sample size.

What is Known
Pediatric upper gastrointestinal bleeding (UGIB) has a mortality rate of ~2%.Endoscopic treatments for UGIB in children include injections, mechanical devices, thermal therapies, and topical agents.Hemostatic powders are commonly used but may obscure visibility and clog the catheter.PuraStat®, a transparent hemostatic gel used successfully in adult UGIB, lacks sufficient data on its safety and efficacy in pediatric patients.

Pediatric upper gastrointestinal bleeding (UGIB) has a mortality rate of ~2%.

Endoscopic treatments for UGIB in children include injections, mechanical devices, thermal therapies, and topical agents.

Hemostatic powders are commonly used but may obscure visibility and clog the catheter.

PuraStat®, a transparent hemostatic gel used successfully in adult UGIB, lacks sufficient data on its safety and efficacy in pediatric patients.

What is New
PuraStat® was easy to use, appeared to be beneficial, and was well‐tolerated as adjunctive hemostatic therapy in four pediatric UGIB cases.PuraStat's® transparent gel preserved endoscopic visibility, addressing potential limitations seen with hemostatic powders.This case series suggests the potential for PuraStat® as a promising adjunctive hemostatic option for pediatric UGIB.

PuraStat® was easy to use, appeared to be beneficial, and was well‐tolerated as adjunctive hemostatic therapy in four pediatric UGIB cases.

PuraStat's® transparent gel preserved endoscopic visibility, addressing potential limitations seen with hemostatic powders.

This case series suggests the potential for PuraStat® as a promising adjunctive hemostatic option for pediatric UGIB.