Balloon repositioning of intrathoracic upside-down stomach and fixation by percutaneous endoscopic gastrostomy

Paraesophageal type or mixed type esophageal hiatal hernia causes intrathoracic prolapse or torsion of the greater portion of the stomach; the greater curvature comprises the highest position. The condition is called upsidedown stomach or intrathoracic stomach. To treat intrathoracic stomach, the hernia gate should be closed and the stomach should be fixed after it is placed in the abdominal cavity. The procedure requires laparotomy under general anesthesia or laparoscopic surgery. Recently, several studies have reported that percutaneous endoscopic gastrostomy (PEG) is useful for treating intrathoracic stomach. It is relatively difficult to endoscopically place the intrathoracic stomach in the abdominal cavity. We created a new method to place intrathoracic stomach in the abdominal cavity by inserting a gastric balloon, then move forward to the PEG procedure. The method is simple and the result is very satisfactory.