Figure 1Endoscopically guided percutaneous suturing technique. A, An 18-gauge trocar was advanced to the gastric lumen under direct and endoscopic
guidance. A 1-0 silk suture was advanced across the trocar into the gastric lumen.
B, The suture was then externalized through the fistula tract with a biopsy forceps.
C, The trocar was inserted again into the gastric lumen on the opposite side, and the
suture was advanced from the external area into the gastric lumen. D, With a biopsy forceps traversed across the fistula tract, the suture was externalized.
E, The suture was cut to remove the trocar. F, The suture was knotted together. G-H, The knot was pulled to get an external position. I-J, The suture lines were tied with the knot pulled along the long axis of the defect,
allowing the knot to slide to the gastric side.