Supplementary Material for: Endoscopic Hemostatic Treatment with a Novel Self-assembling Peptide Gel for Precut Fistulotomy-related Bleeding

Introduction: Precut fistulotomy is of interest as one of the salvage techniques for selective bile duct cannulation (SBDC) using endoscopic retrograde cholangiopancreatography (ERCP). Of the various endoscopic treatments reported to date for bleeding associated with papillotomy incision, endoscopic hemostasis treatment with a novel self-assembling peptide (SAP) matrix-forming gel (TDM-621) (3-D Matrix Ltd., Tokyo, Japan) remains only insufficiently reported in the literature. Case presentation: We herein report 6 cases of precut fistulotomy-related bleeding successfully treated with endoscopic hemostasis treatment with TDM-621, i.e., 5 and 1 cases during and after precut fistulotomy, respectively, in 2 males and 4 females aged 68 to 96 years (mean age, 85 years), 3 of whom had been on antithrombotic drugs. Types of bleeding treated included oozing bleeding (n = 5) and oozing bleeding from a visible vessel (n = 1). In all cases, complete hemostasis was achieved with TDM-621 without causing rebleeding. Conclusion: Endoscopic hemostasis with TDM-621 may prove effective for precut fistulotomy-related bleeding and represent a potential modality of first choice in hemostasis. In addition, endoscopic hemostasis with combined modality therapy using TDM-621 and endoscopic hemoclips may prove effective for bleeding from visible vessels.

引言：经内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography, ERCP）行选择性胆管插管（selective bile duct cannulation, SBDC）的补救技术中，预切开瘘管切开术（precut fistulotomy）是备受关注的技术之一。截至目前，针对乳头切开术切口相关出血的各类内镜治疗方案已有诸多报道，但采用新型自组装肽（self-assembling peptide, SAP）基质形成凝胶（TDM-621，日本东京3-D Matrix有限公司）实施内镜止血治疗的相关文献仍较为匮乏。

病例报告：本文报告6例经TDM-621内镜止血治疗成功控制的预切开瘘管切开术相关出血病例。患者为2名男性、4名女性，年龄68~96岁（平均年龄85岁）；其中5例出血发生于预切开瘘管切开术术中，1例发生于术后，3例患者术前曾接受抗血栓药物治疗。本次治疗覆盖的出血类型包括创面渗血（n=5）及可见血管源性渗血（n=1）；所有病例均通过TDM-621实现完全止血，未出现再出血情况。

结论：采用TDM-621实施内镜止血，对预切开瘘管切开术相关出血可能具有良好疗效，有望成为止血治疗的首选潜在方案。此外，联合使用TDM-621与内镜止血夹的多模式内镜止血治疗，对可见血管源性出血可能同样有效。