A technique of percutaneous endoscopic intragastric surgery

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Abstract
A technique of percutaneous endoscopic intragastric surgery (PEIGS) is described. In PEIGS, three cannulae are inserted percutaneously into the gastric cavity, using a technique similar to that used in percutaneous endoscopic gastrostomy. Through these intragastric cannulae a rigid endoscope and two surgical instruments are brought into the gastric cavity. The gastric cavity is dilated by CO2 insufflation and large en bloc mucosectomy is carried out using a grasper and a high-frequency hook under percutaneous gastroscopic view. The mucosal defect is closed by suturing. After removal of the intragastric cannulae, the wounds in the stomach are closed by suturing. We also report a case with a large sessile adenoma in the gastric antrum containing a cancer focus. In this case we were able to remove the lesion (measuring 80 mm at its greatest diameter) in en bloc fashion by the PEIGS technique. During the follow-up period of 3 years the patient has had no tumour recurrence and enjoys an excellent quality of life. PEIGS can be a preferred choice of therapy in selected patients with sessile adenomas and carcinoma in situ of the stomach, and may also be used for other pathologies, such as pancreatic pseudocyst or intractable gastric haemorrhage.