Intragastric stapled pancreatic pseudocystgastrostomy under endoscopic guidance

Drainage of cystic contents is the standard treatment for case of pancreatic pseudocyst (PP) with symptoms, complications, or enlargement of the cyst itself. Here, we report an intragastric stapled pancreatic pseudocystgastrostomy involving a combination of laparoscopy and transoral endoscopy. The patient was a 56-year-old man with a history of heavy alcohol intake. He complained of abdominal pain and high fever during hospitalization because of pancreatitis. Diagnostic imaging revealed a large pseudocyst expanding from the pancreatic parenchyma to the anterior abdominal wall. Intragastric stapled pancreatic pseudocystgastrostomy under endoscopic guidance was performed for relief of compression and continuous fever. A 12-mm port was inserted into the peritoneal cavity in the subumbilical region to create a pneumoperitoneum. Initially, an endoscope was inserted transorally into the stomach to identify the region of the posterior gastric wall compressed by the cyst. Two 12-mm ports were created in the stomach using a Funada-style percutaneous endoscopic gastrostomy kit. After penetrating the gastric wall and the PP with laparoscopic coagulating shears, 950 mL of cyst fluid was aspirated. A cystgastrostomy was then accomplished using an Endo-GIA linear stapler. A 5-mm port was added, and reinforcement of the connection between the posterior gastric wall and the PP was performed by hand sewing. There were no intraoperative complications, and all wounds were closed from the outside. Oral intake was started on postoperative day 3, and the postoperative course was uneventful. There was no recurrence during a follow-up period of 36 months. As intragastric stapled pancreatic pseudocystgastrostomy under endoscopic guidance is safe and effective, it can be considered a useful alternative procedure for treatment of symptomatic PP.