LAUSR

Simple hepatic cysts are common benign liver lesions which are usually asymptomatic and discovered incidentally. However, larger lesions may need surgical treatment if patients present with abdominal pain, epigastric fullness, or early satiety [1]. American Society of Gastroenterology clinical practice guidelines recommend that symptomatic simple hepatic cysts may be managed with laparoscopic deroofing rather than aspiration and sclerotherapy [2]. Naturalorifice transluminal endoscopic surgery (NOTES) has been developed as a step towards less invasive procedures [3]. With the development of digestive endoscopy, some researchers have used endoscopic ultrasound-guided fine-needle aspiration or NOTES technology for cystic fluid aspiration. Herein, we report a novel approach to smoothly achieving unroofing of simple hepatic cysts, called endoscopic transgastric hepatic cyst deroofing (ETGHCD). A 73-year-old man complained about abdominal pain and epigastric fullness, which was significantly impacting on his daily life. Abdominal computed tomography and ultrasonography revealed an 8-cm simple cyst located in the right liver as the underlying disease. To address the issue we performed ETGHCD on the patient. During the procedure the anterior wall of the gastric antrum was perforated with a sterile colonoscope. The cyst was found at the lower edge of segment IV of the liver. After endoscopic ultrasonography reconfirmed the cyst, transparent liquid was extracted with a 23-G puncture E-Videos