PURPOSE: Percutaneous endoscopic gastrostomy (PEG) is the preferable method to provide enteral nutrition for a longer time period. Safe placement of a PEG tube requires passage of the esophagus and transillumination of the stomach through the abdominal wall. Surgical placement of a PEG tube has been shown to be feasible although the local complication rate ranges above the endoscopic procedure. We are presenting a new technique (percutaneous laparoscopically assisted gastrostomy, PLAG) to provide enteral access for patients with pharyngoesophageal obstruction not suitable for PEG placement. METHODS: We have developed a laparoscopic method that allows full control of the stoma location at the anterior gastric wall. The tube has a deployable bumper mechanism, which can be inserted through a minimal gastric incision. Combined with the fixation by transcutaneous sutures, the risk for leakage or dislodgement is low. RESULTS: Fifty-one PLAGs were inserted in 45 male and six female patients suffering from pharyngoesophageal obstruction due to malignancy. Patients were referred after unsuccessful endoscopic PEG placement (n = 39) or received their PLAG when they underwent staging laparoscopy (n = 12). Success rate was 96.2%. No procedure-related mortality was observed. Infectious complications occurred in three (5.9%) cases. In five patients, minor leaks were managed conservatively (n = 4) or required relaparoscopy (n = 1) and placement of an additional suture (overall complication rate of 15.8%, n = 8). Nutritional goals were reached after 7.8 ± 2.3 days. CONCLUSION: PLAG is a safe and easy procedure. It can well be used to provide enteral access for patients with pharyngoesophageal obstruction not suitable for endoscopic PEG placement.
PURPOSE: Percutaneous endoscopic gastrostomy (PEG) is the preferable method to provide enteral nutrition for a longer time period. Safe placement of a PEG tube requires passage of the esophagus and transillumination of the stomach through the abdominal wall. Surgical placement of a PEG tube has been shown to be feasible although the local complication rate ranges above the endoscopic procedure. We are presenting a new technique (percutaneous laparoscopically assisted gastrostomy, PLAG) to provide enteral access for patients with pharyngoesophageal obstruction not suitable for PEG placement. METHODS: We have developed a laparoscopic method that allows full control of the stoma location at the anterior gastric wall. The tube has a deployable bumper mechanism, which can be inserted through a minimal gastric incision. Combined with the fixation by transcutaneous sutures, the risk for leakage or dislodgement is low. RESULTS: Fifty-one PLAGs were inserted in 45 male and six female patients suffering from pharyngoesophageal obstruction due to malignancy. Patients were referred after unsuccessful endoscopic PEG placement (n = 39) or received their PLAG when they underwent staging laparoscopy (n = 12). Success rate was 96.2%. No procedure-related mortality was observed. Infectious complications occurred in three (5.9%) cases. In five patients, minor leaks were managed conservatively (n = 4) or required relaparoscopy (n = 1) and placement of an additional suture (overall complication rate of 15.8%, n = 8). Nutritional goals were reached after 7.8 ± 2.3 days. CONCLUSION: PLAG is a safe and easy procedure. It can well be used to provide enteral access for patients with pharyngoesophageal obstruction not suitable for endoscopic PEG placement.
Authors: Chr Löser; G Aschl; X Hébuterne; E M H Mathus-Vliegen; M Muscaritoli; Y Niv; H Rollins; P Singer; R H Skelly Journal: Clin Nutr Date: 2005-10 Impact factor: 7.324
Authors: W Amann; H J Mischinger; A Berger; G Rosanelli; W Schweiger; G Werkgartner; J Fruhwirth; H Hauser Journal: Surg Endosc Date: 1997-07 Impact factor: 4.584
Authors: J M Barkmeier; S O Trerotola; E A Wiebke; S Sherman; V J Harris; J J Snidow; M S Johnson; W J Rogers; X H Zhou Journal: Cardiovasc Intervent Radiol Date: 1998 Jul-Aug Impact factor: 2.740
Authors: Anand Rajan; Peerapol Wangrattanapranee; Jonathan Kessler; Trilokesh Dey Kidambi; James H Tabibian Journal: World J Gastrointest Surg Date: 2022-04-27