Self-Assembling Hemostatic Peptide Gel Used to Successfully Treat Rectal Ulcer in Radiation-Associated Vascular Ectasia: A Case Report

BACKGROUND Radiation-associated vascular ectasia, formerly known as radiation proctitis, is a known gastrointestinal complication of radiation therapy. Rectal ulcers in the setting of radiation-associated vascular ectasia are particularly challenging to treat. They are often refractory to conventional medical and endoscopic therapies and cause significant morbidity for patients. Self-assembling hemostatic peptide gel is an endoscopic tool used primarily for hemostasis but has also been hypothesized to have mucosal repair properties. CASE REPORT A 41-year-old woman with a history of cervical adenocarcinoma presented with abdominal pain and rectal bleeding several months after brachytherapy and external beam radiation therapy. Conservative therapy with topical pramoxine was ineffective, so she underwent colonoscopy, which revealed a non-bleeding rectal ulcer in the setting of bleeding radiation-associated vascular ectasia. Argon plasma coagulation was used to treat the bleeding vascular ectasia, but the ulcer was treated solely with self-assembling hemostatic peptide gel. A follow-up endoscopy two months later showed complete resolution of the ulcer. CONCLUSIONS The mucosal repair properties of the self-assembling hemostatic peptide gel, an endoscopic product initially designed for hemostasis, are highlighted by this case in which a non-hemorrhagic ulcer was successfully treated. Furthermore, this is a novel use of the self-assembling hemostatic peptide gel in the setting of radiation-associated vascular ectasia and may represent a useful addition to the endoscopist's toolkit for managing a challenging condition.