Recently, polyglycolic acid (PGA) sheets and fibrin glue have been reported to close
perforations in several areas of the gastrointestinal tract [1]
[2]
[3]
[4]
[5]. However, delayed perforation after colonic endoscopic submucosal dissection (ESD)
usually requires emergency surgery. We report on a case of delayed perforation after
colonic ESD that was treated with PGA sheets and fibrin glue.
An 81-year-old man with a 40 mm laterally spreading tumor in the ascending colon underwent
ESD without perforation ([Fig. 1]). On postoperative Day 2, he had high fever and abdominal pain, and computed tomography
showed free air. Conservative treatment with antibiotics improved his symptoms and
blood test findings; however, the free air persisted. Colonoscopy revealed a small
perforation on the ESD ulcer. Therefore, we attempted to close the perforation through
endoscopic closure using PGA sheets and fibrin glue ([Video 1]).
Fig. 1 Endoscopic view showing no perforation after colorectal endoscopic submucosal dissection.
Video 1 Endoscopic closure using polyglycolic acid sheets for delayed perforation after colonic
endoscopic submucosal dissection.
Initially, the PGA sheet (Neoveil; Gunze, Kyoto, Japan) was cut into 10 × 10 mm pieces,
and then, the perforation site was filled and covered with these pieces using biopsy
forceps through the scope channel of a colonoscope (PCF-Q260JI; Olympus, Tokyo, Japan)
([Fig. 2 a]). Thereafter, fibrin glue (Beriplast P Combi-Set; CSL Behring Pharma, Tokyo, Japan)
and endoclips were applied ([Fig. 2 b]).
Fig. 2 Closure of perforation using polyglycolic acid (PGA) sheets and fibrin glue. a The perforation site was covered with small PGA sheets using biopsy forceps through
the scope channel of an upper gastrointestinal endoscope. b Fibrin glue and endoclips were applied. c The perforation site was covered with regenerating tissue 2 weeks later. d Endoscopic view showing the ulcer scar 3 months later.
Two weeks after the procedure, the perforation site was covered with regenerating
tissue ([Fig. 2 c]), and oral intake was initiated. Post-ESD ulcer scarring was observed after 3 months
([Fig. 2 d]).
The findings of the present case suggest that PGA sheets and fibrin glue can be used
to close delayed perforation after colonic ESD.
Endoscopy_UCTN_Code_CPL_1AJ_2AH
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