Endoscopic closure using polyglycolic acid sheets for delayed perforation after colonic endoscopic submucosal dissection
09 August 2019 (online)
Recently, polyglycolic acid (PGA) sheets and fibrin glue have been reported to close perforations in several areas of the gastrointestinal tract     . 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]).
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]).
The findings of the present case suggest that PGA sheets and fibrin glue can be used to close delayed perforation after colonic ESD.
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