title: Mini-laparoscopically guided percutaneous gastrostomy and jejunostomy.
abstract: BACKGROUND
  Percutaneous endoscopic tube placement can be problematic under certain circumstances: absence of transillumination of the abdominal wall, percutaneous jejunostomy in patients with a PEG tube and recurrent aspiration, enteral feeding access after gastrectomy, and obstruction of the upper GI tract. As an alternative in these problematic situations, a technique was developed for placing feeding tubes under visual control by using mini-laparoscopy.
  
  
  METHODS
  Placement of a feeding tube with mini-laparoscopy with the patient under conscious sedation was considered for 17 patients in whom standard PEG placement was impossible. Techniques used were the following: combined mini-laparoscopy/endoscopy for placement of a percutaneous gastrostomy or jejunostomy, and mini-laparoscopic-guided direct tube placement in cases of obstruction of the upper GI tract.
  
  
  METHODS
  In 13 patients, mini-laparoscopic-assisted tube placement was successful. In 4 patients, adhesions or peritoneal carcinomatosis prevented laparoscopic visualization of the stomach or small bowel. The combined mini-laparoscopic/endoscopic approach allowed a successful insertion of gastric tubes in 6 patients and jejunal tubes in 4 patients. Direct insertion of a percutaneous endoscopic jejunostomy tube without enteroscopy was feasible in all 3 patients with obstruction of the upper GI tract. No complication occurred.
  
  
  CONCLUSIONS
  Mini-laparoscopy-assisted tube placement is a simple and safe alternative when endoscopic percutaneous tube placement is problematic or not feasible.
authors.affiliation: Department of Medicine, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Denzer
authors.forename: Klaus
authors.initials: K
authors.lastname: Mergener
authors.forename: Stefan
authors.initials: S
authors.lastname: Kanzler
authors.forename: Ralf
authors.initials: R
authors.lastname: Kiesslich
authors.forename: Ilka
authors.initials: I
authors.lastname: Helmreich-Becker
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
mesh_terms: D000328:Adult; D000368:Aged; D016292:Procedural Sedation; D004750:Enteral Nutrition / Q000295:instrumentation; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged