LAUSR

A man aged in his 70s presented with a 20-mm, 0-IIa, laterally spreading tumor in the distal transverse colon. Indigo carmine spray revealed fold convergence (▶Fig. 1). The lesion underwent endoscopic submucosal dissection (ESD) and the defect was closed using endoclips. After 2 days, abdominal pain developed. A nonenhanced computed tomography scan of the abdomen revealed free air and increased density of fat tissue around the endoclips inserted during ESD (▶Fig. 2). A delayed perforation was diagnosed. No manifestations, except mild abdominal pain, were observed. After consulting with the surgeon, we concluded that emergency surgery was not indicated at that time because of the small amount of free air, pain with tolerance, stable vital signs, and good results on physical examination. Colonoscopy revealed a small defect at the edge of the ulcer with clips (▶Fig. 3). The defect was covered using a polyglycolic acid (PGA) sheet secured with endoclips (▶Fig. 4). Fibrin glue was not applied (▶Video 1). Surveillance colonoscopy 1 year later revealed a clearly healed ESD scar (▶Fig. 5). PGA has been used extensively to treat delayed perforations after colorectal ESD [1]. Fibrin glue is used in combination with PGA sheets in various organs, including the colon and esophagus [2, 3]. As the colon is in the lower part of the intestine, the PGA sheet may detach, even if the patient is fasting. Therefore, we used endoclips instead of fibrin glue to secure the PGA sheet. Surveillance colonoscopy revealed clean mucosal healing 1 year after ESD. However, the mechanism underlying PGA-induced wound healing remains unknown [3]. Considering a previous report showing fibroblast migration by PGA [4], and the important role of fibroblasts and myofibroblasts in the repair E-Videos