title: Laparoscopic-assisted percutaneous endoscopic transgastrostomy jejunostomy.
abstract: OBJECTIVE
  New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure.
  
  
  METHODS
  In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination.
  
  
  RESULTS
  Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day.
  
  
  CONCLUSIONS
  LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt.
authors.affiliation: "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Surgery, Regional Institute of Oncology Iasi, Second Department of Oncologic Surgery, Iasi, Romania.
authors.forename: Mihail-Gabriel
authors.initials: MG
authors.lastname: Dimofte
authors.affiliation: "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Surgery, Regional Institute of Oncology Iasi, Second Department of Oncologic Surgery, Iasi, Romania.
authors.forename: Vlad
authors.initials: V
authors.lastname: Porumb
authors.affiliation: "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Surgery, Regional Institute of Oncology Iasi, Second Department of Oncologic Surgery, Iasi, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Nicolescu
authors.affiliation: "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Anaesthesia and Intensive Care, Regional Institute of Oncology Iasi, Department of Anaesthesia and Intensive Care, Iasi, Romania.
authors.forename: Irina
authors.initials: I
authors.lastname: Ristescu
authors.affiliation: "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Surgery, Regional Institute of Oncology Iasi, Second Department of Oncologic Surgery, Iasi, Romania.
authors.forename: Sorinel
authors.initials: S
authors.lastname: Lunca
mesh_terms: D000368:Aged; D004750:Enteral Nutrition; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000601:surgery
keywords: LAPEG-J; Laparoscopy; Parkinson disease