Endoscopy 2020; 52(01): E11-E12
DOI: 10.1055/a-0978-4501
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic closure using polyglycolic acid sheets for delayed perforation after colonic endoscopic submucosal dissection

Yasuaki Nagami
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Shusei Fukunaga
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Atsushi Kanamori
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Taishi Sakai
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Masaki Ominami
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Toshio Watanabe
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Yasuhiro Fujiwara
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
› Author Affiliations
Further Information

Corresponding author

Yasuaki Nagami, MD
Department of Gastroenterology
Osaka City University Graduate School of Medicine
1-4-3 Asahimachi
Abeno-ku, Osaka, 545-8585
Japan   
Fax: +81-6-66453813   

Publication History

Publication Date:
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 [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]).

Zoom Image
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.


Quality:

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]).

Zoom Image
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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Competing interests

None


Corresponding author

Yasuaki Nagami, MD
Department of Gastroenterology
Osaka City University Graduate School of Medicine
1-4-3 Asahimachi
Abeno-ku, Osaka, 545-8585
Japan   
Fax: +81-6-66453813   


Zoom Image
Fig. 1 Endoscopic view showing no perforation after colorectal endoscopic submucosal dissection.
Zoom Image
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.