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Recently, polyglycolic acid (PGA) sheets and fibrin glue have been reported to close perforations in several areas of the gastrointestinal tract [1–5]. 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 40mm 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). Initially, the PGA sheet (Neoveil; Gunze, Kyoto, Japan) was cut into 10×10mm 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 E-Videos

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