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DOI: 10.1055/s-0034-1390730
Application of polyglycolic acid sheets for delayed perforation after endoscopic submucosal dissection of early gastric cancer
Publication History
Publication Date:
20 January 2015 (online)
![](https://www.thieme-connect.de/media/endoscopy/2015S01/lookinside/thumbnails/10.1055-s-0034-1390730-1.jpg)
Since being developed and established in Japan, endoscopic submucosal dissection (ESD) has been widely used as a standard treatment for early gastric cancer [1]. Delayed perforation is an occasional complication of ESD, and despite its low incidence, it is a serious complication frequently requiring emergency operation [2] [3] [4]. Polyglycolic acid (PGA) sheets (Neoveil; Gunze Co., Japan), composed of bioabsorbable material, can be used to strengthen the ulcer floor after ESD [5]. We report the successful use of PGA sheets as a conservative treatment for delayed perforation.
A 62-year-old man had early gastric cancer located in the posterior wall of the upper stomach. ESD was completed in 31 minutes with no complications or perforations ([Fig. 1]).
![](https://www.thieme-connect.de/media/endoscopy/2015S01/thumbnails/10-1055-s-0034-1390730-i978cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
On postoperative day (POD) 1, the patient was allowed to resume water intake. However, on POD 2, because of a fever as high as 39° C and a complaint of persistent epigastric pain, abdominal radiography was performed and revealed free air beneath the diaphragm. Esophagogastroduodenoscopy (EGD) on the same day revealed a 7-mm perforation and thin ulcer floor ([Fig. 2 a]) with unsuccessful endoclip closure, resulting in a tear in the ulcer floor owing to the fragile nature of the tissue after 2 days of inflammation.
![](https://www.thieme-connect.de/media/endoscopy/2015S01/thumbnails/10-1055-s-0034-1390730-i978cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
We therefore cut a PGA sheet ([Fig. 2 b]) into strips and placed them on the site of perforation ([Fig. 2 b]). After shielding with PGA sheets, complaints subsided on POD 3. Complete coverage of the perforation site with PGA sheets was confirmed by EGD on POD 7 ([Fig. 3 a]), and the sheets had peeled off spontaneously by POD 13, revealing a completely healed perforation site ([Fig. 3 b]). Scarring of the perforation site was observed after 2 months ([Fig. 3 c]). [Video 1] shows the PGA strips being placed on the site of perforation on postoperative day (POD) 2 followed by endoscopic views of the perforation site on POD 7, POD 13, and 2 months later.
![](https://www.thieme-connect.de/media/endoscopy/2015S01/thumbnails/10-1055-s-0034-1390730-i978cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Quality:
Endoscopists may benefit from using the PGA shielding/coating method when it is difficult to close a perforation using clips.
Endoscopy_UCTN_Code_CPL_1AJ_2AD
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References
- 1 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
- 2 Hanaoka N, Uedo N, Ishihara R et al. Clinical features and outcomes of delayed perforation after endoscopic submucosal dissection for early gastric cancer. Endoscopy 2010; 42: 1112-1115
- 3 Ikezawa K, Michida T, Iwahashi K et al. Delayed perforation occurring after endoscopic submucosal dissection for early gastric cancer. Gastric Cancer 2012; 15: 111-114
- 4 Sekiguchi M, Suzuki H, Oda I et al. Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection. World J Gastroenterol 2012; 18: 4224-4227
- 5 Takimoto K, Toyonaga T, Matsuyama K. Endoscopic tissue shielding to prevent delayed perforation associated with endoscopic submucosal dissection for duodenal neoplasms. Endoscopy 2012; 44: E414-E415