Polyglycolic Acid Shield Prevents Repeated Delayed Bleeding After Endoscopic Stricturotomy for Anastomotic Stricture in Crohn's Disease: A Case Report

Endoscopic stricturotomy (ES) is a novel approach for treating benign strictures of the lower gastrointestinal tract. However, it is performed at a limited number of facilities, and strategies for preventing complications have not yet been established. We performed ES for ileo-sigmoid anastomosis associated with Crohn's disease (CD). Although endoscopic dilatation was successful, delayed bleeding occurred. Endoscopic hemostasis provided temporary relief, but delayed bleeding recurred nine times within 17 days after ES. Combined hemostatic treatments with vascular forceps soft coagulation, biocompatible synthetic peptide gel, and endoscopic clips failed to stop recurrent bleeding. Infliximab infusion was also unsuccessful. Finally, wound coverage with polyglycolic acid (PGA) sheets prevented rebleeding and avoided abdominal surgery. Here, we report that covering with a PGA sheet and fibrin glue may be useful in preventing recurrent delayed bleeding after ES for anastomosis associated with CD.