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 polyeth ylene tube that is inserted by the:"thread pull through" method. A trocar v alve is mounted-at the external tip of the tube. Four pseudocysts were trea ted in three patients. The retrogastric pseudocysts were punctured through the device under endoscopic (n = 2): and CT (n = 2) guidance. External drai nage was used for 3 to 5 days; thereafter the drain was cut and internalize d. 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 t he pseudocysts resolved completely. One patient had to undergo pseudocystoj ejunostomy for an infected pseudocyst containing large amounts of necrotic material. Conclusions: We believe that our new device is valuable to the further deve lopment of intragastric surgery and can be used to safely perform pseudocys togastrostomy.