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：内镜下乳头预切开术是采用内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）实施选择性胆管插管（selective bile duct cannulation, SBDC）的常用补救性技术之一，具有重要临床研究价值。目前已有多项关于乳头切开术后出血的内镜治疗方案见诸报道，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）的内镜下止血治疗，在相关文献中的报道仍较为有限。

病例报告：本文报告6例经TDM-621内镜下止血治疗成功治愈的内镜下乳头预切开术相关出血病例：其中5例为术中出血，1例为术后出血；患者包括2名男性与4名女性，年龄68~96岁（平均年龄85岁），其中3例曾长期服用抗血栓药物。本次治疗覆盖的出血类型包括渗血（5例）及可见血管源性渗血（1例）。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的内镜下止血治疗对内镜下乳头预切开术相关出血可能具有良好疗效，有望成为此类出血止血治疗的首选潜在方案。此外，联合应用TDM-621与内镜止血夹的多模式内镜下止血治疗，对可见血管源性出血同样可能具有良好疗效。