title: Laparoscopic-assisted percutaneous endoscopic gastrostomy: a simple and efficient technique for disabled elderly patients.
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomy (PEG) is a simplified catheter placement procedure for alimentation. Although the endoscopic approach to gastrostomy tube placement is a safe and well-tolerated procedure in most patients, the PEG procedure is difficult in elderly patients disabled since childhood who have severe scoliosis and malpositioning of the stomach. We describe a simple and effective laparoscopic-assisted PEG (LAPEG) technique that can be used for catheter placement in severely disabled patients.
  
  
  METHODS
  Thirteen severely disabled patients aged 14-57 years underwent gastrostomy tube placement with the LAPEG technique. After general anesthesia was achieved, an endoscope was placed into the stomach. Then, a 5-mm camera port was inserted at the umbilicus, and a 3-mm working port was inserted to identify and lift the optimal site for gastrostomy tube placement. After the 4-point fixation of the stomach, the 20-Fr gastrostomy tube was placed under endoscopic and laparoscopic observation.
  
  
  RESULTS
  All patients tolerated the procedure well, and there were no major complications. The procedure was successful, and all patients could feed via the tube.
  
  
  CONCLUSIONS
  Elderly disabled patients who have been bedridden since childhood often have severe scoliosis and malpositioning of the stomach. Our LAPEG procedure is effective, well tolerated, and safe for gastrostomy tube placement in such elderly patients.
authors.affiliation: Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Satoko
authors.initials: S
authors.lastname: Nose
authors.forename: Ryuta
authors.initials: R
authors.lastname: Saka
mesh_terms: D000293:Adolescent; D000328:Adult; D006233:Persons with Disabilities; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012600:Scoliosis; D013270:Stomach / Q000601:surgery*; D055815:Young Adult
keywords: PEG; disability; gastrostomy; laparoscopy