One Port Intragastric Endoscopic Surgery for Giant Gastric Polyp

Abstract

We treated a case of giant gastric polyp using a new resection technique-one port intragastric endoscopic surgery. A 84-year-old male was admitted to our department suffering from anemia. Gastric fiberscopy and an upper GI series revealed a giant adenomatous polyp in the distal region of the stomach. The lesion was 40 mm in diameter, with a stalk of 20 mm. We determined that it would be difficult to remove by conservative endoscopic procedures because of the thick stalk. The surgery was performed under general anesthesia, in the supine position. A panendoscope with 2 channels was inserted through the mouth. First, the anterior gastric wall was fixed to the abdominal wall using Funada fixing equipment. A 12-mm trocar was then inserted into the stomach to the left upper quadrant of the abdomen, after observation. The tumor was pulled by snare wire through the endoscope and resected with a 45 mm linear stapler that was inserted through the trocar. No bleeding or leakage were observed. The puncture wound in the stomach was closed with endoscopic clips. The abdominal wound was closed by hand, and the procedure was completed without difficulty. The postoperative course was uneventful, and the patient was discharged from hospital on the 7th postoperative day, after gastric fiberscopy observation.