Innovative delivery method using a detachable device to deliver a large polyglycolic acid sheet to a gastric ulcer perforation

Many reports have indicated the efficacy of polyglycolic acid (PGA) sheets with fibrin glue for the treatment of perforations or preventing stricture following endoscopic submucosal dissection (ESD) [1, 2]. However, the delivery method of such a thin membrane such as the PGA sheet (especially large sheets) into the stomach without getting wet has not been reported. An 89-year-old woman was diagnosed with early gastric cancer. Following endoscopic submucosal dissection, a perforation was induced by cytomegalovirus infection (▶Fig. 1 a), and accompanied by severe immune suppression due to oral administration of methotrexate for rheumatoid arthritis. A drip infusion of ganciclovir was administered for the infection. For treatment of the perforation, we developed a novel detachable device to deliver a large, 16 cm2 PGA sheet to completely cover the perforation (▶Video1). Two balloons (endoscopic injection sclerotherapy balloons, 11mm in diameter, 50mm in length; TOP Co., Tokyo, Japan) were connected by sewing togethE-Videos