Clin Endosc.  2021 Nov;54(6):864-871. 10.5946/ce.2021.004.

The Additive Effect of Platelet-Rich Plasma in the Treatment of Actively Bleeding Peptic Ulcer

• Seleem WM
• Hanafy AS

• KMID: 2522707
• DOI: http://doi.org/10.5946/ce.2021.004

Abstract

Background/Aims
Peptic ulcer bleeding is the most common cause of upper gastrointestinal tract bleeding. Platelet-rich plasma (PRP) enhances tissue repair, and is therefore used in various medical treatments. A combination of mechanical or electrothermal hemostasis has been recommended for upper gastrointestinal tract bleeding treatment. This study evaluated the additive efficacy of PRP in bleeding peptic ulcer hemostasis and recovery.
Methods
Eighty patients with peptic ulcer bleeding were initially treated by hemoclipping, and were randomly chosen for either additional PRP (n=40) or additional epinephrine (n=40) injections. Both groups were compared with regard to achieving hemostasis and the frequency of complications.
Results
Hemostasis was immediately achieved in both groups. Two patients (5%) in the PRP group and 8 (20%) patients in the epinephrine group experienced rebleeding after 15.9±2.8 and 12.3±3.7 days, respectively. They were managed by PRP injection in addition to proton pump inhibitor infusion. Hemoglobin was substantially increased in the PRP-treated group with full recovery occurring in 60.5% compared to 31.3% of patients in the epinephrine group (p=0.001). There was no recurrent bleeding in the PRP group, but 4/32 (12.5%) patients in the epinephrine group exhibited rebleeding.
Conclusions
PRP showed additional benefit in reducing peptic ulcer bleeding with no reported significant complications. Clinical trial (NCT03733171).

Keyword

Gastric ulcer; Healing; Platelet-rich plasma; Upper gastrointestinal bleeding

Figure

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  Fig. 1. Flowchart of the studied population. PRP, platelet-rich plasma.

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  Fig. 2. (A, B) Actively bleeding duodenal ulcer. (C) During injection of platelet-rich plasma (PRP). (D) Hemostasis after PRP injection. (E) Effect of PRP after 1 month. (F) Effect of PRP after 3 months. (G) Complete healing after 5 months. (H) The centrifugation device.

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  Fig. 3. Outcomes after endoscopic interventions. PRP, platelet-rich plasma.

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