First clinical application of a newly developed device for intragastric surgery for the treatment of pancreatic pseudocysts.

BACKGROUND

Instruments that have been used during GI endoscopy have always been confined to the accessory channel of the endoscope. We have therefore developed a device that allows transabdominal manipulation in the stomach under gastroscopic control. Here we report the first clinical application of this device, which was used for the drainage of pancreatic pseudocysts.

METHODS

The device is similar to a PEG tube and consists of a 7 mm polyethylene tube that is inserted by the "thread pull through" method. A trocar valve is mounted at the external tip of the tube. Four pseudocysts were treated in three patients. The retrogastric pseudocysts were punctured through the device under endoscopic (n = 2) and CT (n = 2) guidance. External drainage was used for 3 to 5 days; thereafter the drain was cut and internalized. The device was also cut and sealed. After 10 days it was removed as with a standard PEG tube.

RESULTS

No complications related to the device occurred. In two patients the pseudocysts resolved completely. One patient had to undergo pseudocystojejunostomy for an infected pseudocyst containing large amounts of necrotic material.

CONCLUSIONS

We believe that our new device is valuable to the further development of intragastric surgery and can be used to safely perform pseudocystogastrostomy.