Mini-laparoscopically guided percutaneous gastrostomy and jejunostomy.
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.
Denzer
Ulrike
U
Department of Medicine, Johannes Gutenberg University, Mainz, Germany.
Mergener
Klaus
K
Kanzler
Stefan
S
Kiesslich
Ralf
R
Helmreich-Becker
Ilka
I
Galle
Peter R
PR
Lohse
Ansgar W
AW
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