title: Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy.
abstract: There are a variety of techniques for gastrostomy tube placement. Endoscopic and radiologic approaches have almost entirely superseded surgical placement. However, an aging population and significant advancements in modern healthcare have resulted in patients with increasingly complex medical issues or postsurgical anatomy. The rising prevalence of obesity has also created technical challenges for proceduralists of many specialties. When patients with these comorbidities develop the need for long-term enteral nutrition and feeding tube placement, standard approaches such as percutaneous endoscopic gastrostomy (PEG) by endoscopists and percutaneous image-guided gastrostomy (PIG) by interventional radiologists may be technically difficult or impossible. For these challenging situations, laparoscopic-assisted PEG (LAPEG) is an alternative option. LAPEG combines the advantages of PEG with direct intraperitoneal visualization, helping ensure a safe tube placement tract free of intervening organs or structures. In this review, we highlight some of the important factors of first-line gastrostomy techniques, with an emphasis on the utility and procedural technique of LAPEG when they are not feasible.
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, PVUB 2114, MC 694907, Los Angeles, CA, 90095-6949, USA. athaker@mednet.ucla.edu.
authors.forename: Adarsh M
authors.initials: AM
authors.lastname: Thaker
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, PVUB 2114, MC 694907, Los Angeles, CA, 90095-6949, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Sedarat
mesh_terms: D000075202:Contraindications; D004750:Enteral Nutrition / Q000379:methods*; D005773:Gastroscopy / Q000379:methods; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods
keywords: Gastrostomy; Laparoscopic-assisted PEG (LAPEG); Percutaneous endoscopic gastrostomy (PEG); Percutaneous image-guided gastrostomy (PIG)