Laparoendoscopic Percutaneous Endoscopic Gastrostomy in Adults

Gastrostomies: experience and complications with three modalities in a tertiary centre over a 26-year period

Objectives

To describe the complications associated with the different gastrostomy techniques [endoscopic (PEG), radiologic (PRG), and surgical (SG)] performed in the last 26 years in a terciary hospital.

Methods

Retrospective observational study. Patients who underwent gastrostomy at the Virgen del Rocío University Hospital between 1995 and 2021 were included. For PEG, the PULL technique was performed until 2018 and subsequently the PUSH technique predominantly. For PRG, a pigtail catheter was used until 2003, a balloon catheter between 2003 and 2009, and a balloon catheter with gastropexy between 2015 and 2021. For SG, the conventional technique (CSG) was performed until 2009 and since then the laparoscopic assisted percutaneous gastrostomy (PLAG) technique. Descriptive analysis was performed obtaining the median and quartiles of the quantitative variables [P50 (P25-P75)] and the frequency for the qualitative variables [n (%)].The comparison of complications between patients who underwent different techniques was performed with Fisher's test.

Results

n = 1,070 (PEG = 608, PRG = 344, SG = 118). The three most frequent indications were head and neck tumors, neurological diseases and gastroesophageal tumors. The percentage of patients who had any complication was 48.9% (PEG-PULL), 23.7% (PEG-PUSH), 38.5% (pigtail PRG), 39.2% (balloon PRG), 29.7% (balloon with gastropexy PRG), 87.3% (CSG), and 41.26% (PLAG). 2 (0.18%) patients died from gastrostomy-related complications. 18(1.68%) presented with peritonitis and 5 (0.4%) presented with gastrocolic fistula. The rest of the complications were minor.

Conclusion

Gastrostomy in any of its modalities is currently a safe procedure with a low rate of complications, most of which are minor.

Chronic Gastric Dilation-Surgical Management

Background: Chronic dilation of the gastric remnant is a rare complication, although it can be serious. It is due to an exaggerated distension of the gastric remnant after a Roux-en-Y gastric bypass (RYGB). Clinical suspicion and computed tomography (CT) are essential for its diagnosis. Its treatment is by means of a decompressive gastrostomy, which can be percutaneous or surgical, an option that can be carried out in certain patients. We present a clinical case of chronic dilation of the gastric remnant and its laparoscopic surgical resolution. Methods: We present a clinical case of a 67-year-old patient who underwent a RYGB. An abdominal CT scan showed chronic dilation of the gastric remnant. A laparoscopic biopsy and a laparoscopic-assisted percutaneous gastrostomy were performed. Conslusion: The combined percutaneous laparoscopic approach is a good option for cases of chronic gastric dilations of unknown origin, allowing to discover and treat its causes.

Laparoscopic-Percutaneous Combined Gastrostomy: Initial Experience and Description of a Technique

Background: Gastrostomy is a widely used procedure that aims to obtain access to the stomach. Its purpose may be feeding or gastric decompression. Currently, the most common techniques are endoscopic and radiologic. Sometimes, these accesses are not available due to technical or patient-specific factors. In these cases, laparoscopic and percutaneous approaches combined could be an option. The aim of this study was to describe a laparoscopic-percutaneous combined gastrostomy procedure, feasibility, and complications. Materials and Methods: Retrospective descriptive observational study. All patients underwent laparoscopic-percutaneous combined gastrostomy required for feeding or decompressive gastrostomy. We analyzed variables: demographics, surgical indication, operation time, hospitalization stay, success, and morbidity/mortality associated to the procedure. Results: A total of n = 17 patients were recruited (58.8% women and 41.2% men), with mean age of 53. Regarding the indications of laparoscopic-percutaneous combined gastrostomy, 47% were due to upper gastrointestinal/head and neck tumor, 29.4% stomach location in a retrocostal position, 17.7% colonic interposition, and 5.9% acute gastric dilation of remnant after Roux-en-Y gastric bypass. The mean time of the procedure was 25 minutes, and mean hospitalization stay was 1.2 days. The success of the procedure was 100%. No complications and mortality associated with the procedure were reported. Conclusion: Laparoscopic-percutaneous combined gastrostomy is fast, feasible, safe, and cost effective. It is an option in patients where it is not possible to perform standard minimally invasive approaches.

The Effectiveness of Laparoscopic-assisted Percutaneous Endoscopic Gastrostomy in Patients with Unfavorable Anatomy: A Single-center Retrospective Cohort Study

Percutaneous endoscopic gastrostomy (PEG) is an easy means to provide enteral access in patients unable to maintain adequate nutrition via the oral route. In patients with morbid obesity, altered intra-abdominal anatomy due to prior abdominal surgery, the interposition of the colon or other factors precluding endoscopy, feeding tube placement by laparoscopic means (LAPEG) can provide a potentially safe alternative. The objective of this study was to examine the efficacy and outcomes of laparoscopic-assisted placement of PEG in adult patients. This is a retrospective cohort analysis of adult patients, who underwent PEG and/or laparoscopic-assisted percutaneous endoscopic gastrostomy placement (LAPEG) by two surgeons at a single institution. A total of 36 patients underwent PEG and/or LAPEG. No significant differences were found in the total and postoperative length of stay and mortality. There were no procedure-related complications in the LAPEG group versus two in the PEG group (8.7%), but this did not reach statistical significance. LAPEG was 100% successful in gaining enteral feeding access in patients that had failed PEG. The most common reason for PEG placement failure was colonic interposition (39%), followed by intra-abdominal adhesions and gastric displacement by hiatal hernia (each 23%). 38.5% of LAPG procedures could be done via 5-mm single port access, 38.5% required two-port and 23% required three-port access. In conclusion, LAPEG is a feasible minimally invasive alternative to gain enteral feeding access in patients that have failed PEG that does not increase the length of stay, morbidity or mortality.