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Abstract
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.
Highlights
First developed by Michael Gauderer and Jeffry Ponsky in 1980, percutaneous endoscopic gastrostomy (PEG) tubes have been in use for nearly 40 years as a convenient and minimally invasive method for access in patients who are unable to tolerate oral feeding for a variety of reasons [1]
Data were collected from patient health records, using the 2020 International Classification of Disease-10 (ICD-10) and American Medical Association Current Procedural Terminology (CPT) codes to identify Percutaneous endoscopic gastrostomy (PEG) and enteral feeding tube placement in hospitalized patients
No statistically significant differences were noted in patient demographics (Table 1) for either groups including age, gender (17.4 versus 23.1% female, p = 0.68), body-mass index (BMI), or BMI greater than 35 kg/m2 (13.0 versus 15.4 percent, p = 0.85)
Summary
First developed by Michael Gauderer and Jeffry Ponsky in 1980, percutaneous endoscopic gastrostomy (PEG) tubes have been in use for nearly 40 years as a convenient and minimally invasive method for access in patients who are unable to tolerate oral feeding for a variety of reasons [1]. In 1994, Raaf et al published in the Journal of Laparoendoscopic Surgery, a novel method in which laparoscopy was used to aid in the placement of gastric feeding tubes in patients with unfavorable intraabdominal anatomy preventing simple endoscopic placement [2]. There are no published series systematically comparing outcomes of LAPEG and PEG This retrospective cohort study compares the outcomes of patients undergoing PEG and LAPEG in a North American population over a period of two years
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