# Polyglycolic Acid Sheet Application to Refractory Delayed Bleeding After Rectal Endoscopic Submucosal Dissection: A Case Report

## TL;DR

A patient experienced repeated bleeding after a rectal tumor removal procedure, which was successfully managed using a polyglycolic acid sheet.

## Contribution

This case report introduces the use of polyglycolic acid sheets as a potential solution for refractory delayed bleeding after rectal ESD.

## Key findings

- Bleeding recurred multiple times after rectal ESD despite conventional hemostatic measures.
- Application of polyglycolic acid sheets successfully controlled bleeding and promoted healing.
- No further bleeding episodes occurred after PGA sheet application.

## Abstract

A man in his 50s underwent endoscopic submucosal dissection (ESD) for a rectal tumor measuring 28 mm. He was not taking any antithrombotic medication. On the third, 11th, 18th, and 24th days after the procedure, bleeding was observed from different areas of the ulcer bed margin and was managed with hemostatic forceps. Despite epithelization and ulcer healing, delayed bleeding recurred, with the fourth episode being severe, marked by significant bleeding and a decrease in serum hemoglobin level. Although clip closure of the ulcer bed and the application of PuraStat were attempted, they failed to prevent recurrent bleeding. Therefore, polyglycolic acid (PGA) sheets were applied to the ulcer bed during the fourth episode. Four days later, PGA sheets remained on the ulcer bed without any signs of bleeding, and healing continued. No further bleeding episodes occurred. The fact that continuous hemostasis was achieved after application of the PGA sheet without complications suggested that this approach may be an option in future cases of refractory delayed bleeding after rectal ESD.