Efficacy of platelet-rich plasma as a shielding technique after endoscopic mucosal resection in rat and porcine models

Abstract

Background and study aims: The aims were to assess the efficacy of endoscopic application of Platelet-rich plasma (PRP) to prevent delayed perforation and to induce mucosal healing after endoscopic resections.

Patients and methods: Colonic induced lesions were performed in rats (n = 16) and pigs (n = 4). Animals were randomized to receive onto the lesions saline (control) or PRP. Animals underwent endoscopic follow-up. Thermal injury was assessed with a 1 - 4 scale: (1) mucosal necrosis; (2) submucosal necrosis; (3) muscularis propria necrosis; and (4) serosal necrosis

Results: Saline treatment showed 50 % of mortality in rats (P = 0.02). Mean ulcerated area after 48 hours and 7 days was significantly smaller with PRP than with saline (0.27 ± 0.02 cm(2) and 0.08 ± 0.01 cm(2) vs. 0.56 ± 0.1 cm(2) and 0.40 ± 0.06 cm(2); P < 0.001). The incidence of thermal injury was significantly lower with PRP (1.25 ± 0.46) than in controls (2.25 ± 0.50); P = 0.006. The porcine model showed a trend toward higher mucosal restoration in animals treated with PRP than with saline at weeks 1 and 2 (Median area in cm(2): 0.55 and 0.40 vs. 1.32 and 0.79) CONCLUSIONS: Application of PRP to colonic mucosal lesions showed strong healing properties in rat and porcine models.

Conflict of interest statement

Competing interests: None

Figures

Fig. 1

Four-step method to obtain platelet-rich plasma (PRP). a Peripheral blood was drawn from each animal. b PRP was obtained by centrifugation of blood at room temperature. c Three different layers were obtained: erythrocytes at bottom, PRP in the middle, and platelet-poor plasma on the top. d PRP was filled into a syringe.

Fig. 2

Endoscopic shielding technique with platelet-rich plasma. a Tip of the catheter was positioned over the ulcer. b Activated PRP was gently sprayed onto the lesion. c Clot was formed after 1 to 2 minutes. d Clot was firmly adhered (after washing).

Fig. 3

Colonic induced lesions by Coagraspers Haemostatic Forceps in rat model (40 W × 4 sec): Endoscopic view with high-resolution white-light imaging (left) and the corresponding narrowband image (right).

Fig. 4

Colonic EMR-induced lesions in porcine model. EMR was performed with snare polypectomy prior submucosal injection of saline.

Fig. 5

Follow-up in both group of rats at 48 hours and 7 days. Macroscopic images (left) in saline group. Endoscopic follow-up (right) in animals treated with platelet-rich plasma.

Fig. 6

Endoscopic follow-up in porcine model in both treated animals, saline (left) and platelet-rich plasma (right), at baseline, Day 7, and Week 2 of follow-up.

Fig. 7

Histologic study of colon sections with thermal injury in both groups of rats on Day 7. Saline group (left) shows necrosis of the muscularis propia and serosa. Rats treated with platelet-rich plasma (right) show superficial necrosis without injury in muscularis propria.

Fig. 8

Histologic study of colon sections with mucosal resection in both groups of pigs on Day 14. Platelet-rich plasma treated group shows a significant reduction in mucosal inflammation with partial restoration of the epithelium (right), whereas saline group shows less reduction of mucosal inflammation and restoration (left).