Yoshiki Sakaguchi, MD, PhD, Yosuke Tsuji, MD, PhD, Kazuhiko Koike, MD, PhD, Mitsuhiro Fujishiro, MD, PhD, and Kazuhiko Koike, MD, PhD from the University of Tokyo in Tokyo, Japan discuss their video case “Successful closure of a large perforation during colorectal ESD by application of polyglycolic acid sheets and fibrin glue.”

The shielding method with polyglycolic acid (PGA) sheets and fibrin glue is an emerging novel method in endoscopic treatment, with the potential to prevent post-ESD adverse events such as bleeding, perforation, and stricture. In this video case presentation, we have demonstrated how to treat massive colorectal perforations by endoscopically applying this method, and the efficacy of this method.

Figure 1 A, Very large perforation occurred during a colorectal endoscopic submucosal dissection. B, Complete clip closure could not be attained, and polyglycolic acid sheets were adhered to the perforation with fibrin glue, completely filling in the defect.

Endoscopic submucosal dissection (ESD) is an excellent method of treatment because of its high curative resection rate and low recurrence rate, but is known to come with a high risk of perforations. Although conventional endoclips are known to be effective for the management of small perforations, there is a limit to the size of perforations that they can treat, and there is still a clinical need for a method to treat massive perforations.

Although further studies are required for confirmation of the efficacy of the shielding method with PGA sheets and fibrin glue, this method is a promising method which can be applicable regardless of the size of the perforation.

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