{
  "abstract": "Background and aims\n\nPEG is the standard method for long-term enteral access but may fail when anatomical distortion or visceral interposition prevents safe placement. Laparoscopic-assisted PEG combines laparoscopic exposure with endoscopic guidance, providing a minimally invasive rescue technique in such cases.Methoods\n\nWe report a 69-year-old man with advanced mixed salivary gland carcinoma (T4N3bM0) previously treated with bilateral neck dissection and radiotherapy. He developed severe dysphagia secondary to a postradiation esophageal stricture and bilateral vocal cord paralysis, leading to significant malnutrition with weight decline from 72 to 58 kg over 1 year. Long-term enteral feeding was indicated. Two conventional PEG attempts failed because of absent transillumination, and a radiologic gastrostomy attempt was aborted because the transverse colon was interposed between the abdominal wall and the stomach. With the patient under general anesthesia via tracheostomy, laparoscopic-assisted PEG was performed. Laparoscopy identified a superiorly displaced transverse colon overlying the stomach, which was mobilized to create a safe window. A 14F pull-type PEG tube was successfully inserted under combined laparoscopic and endoscopic visualization, confirming intragastric positioning.Results\n\nEnteral feeding began the same day, and recovery was uneventful. Laparoscopic-assisted PEG enabled safe gastrostomy placement after multiple failed approaches.Conclusions\n\nLaparoscopic-assisted PEG is a minimally invasive alternative that avoids the morbidity of formal surgical gastrostomy when PEG or radiologic interventional gastrostomy are not feasible.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel.",
    "Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.",
    "General Surgery Department, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "David Hakimian"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Anat Hershko Moshe"
    },
    {
      "affs": [
        2
      ],
      "name": "Joshua Zev Gottesman"
    },
    {
      "affs": [
        2
      ],
      "name": "Briggite Helou"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Gad Marom"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/99x3hswnw8yb9.bib",
  "cited_by": 0,
  "doi": "10.1016/j.vgie.2026.05.002",
  "fulltext_url": "https://europepmc.org/articles/PMC13688120",
  "id": "99x3hswnw8yb9",
  "issns": [
    "2468-4481"
  ],
  "landing_url": "https://europepmc.org/article/MED/42923296",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Minimally Invasive Surgical Techniques"
    ]
  ],
  "openalex": "W7161548804",
  "pdf_url": "https://europepmc.org/articles/PMC13688120?pdf=render",
  "pmcid": "PMC13688120",
  "pmid": "42923296",
  "published": "2026-05-18",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/99x3hswnw8yb9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:02Z",
      "native_id": "MED:42923296",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42923296"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Minimally Invasive Surgical Techniques",
      "subfield": "surgery"
    }
  ],
  "title": "Combined laparoscopic and endoscopic technique for safe percutaneous endoscopic gastrostomy in a patient with challenging abdominal anatomy.",
  "title_text": "Combined laparoscopic and endoscopic technique for safe percutaneous endoscopic gastrostomy in a patient with challenging abdominal anatomy.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:02Z",
  "url": "https://research.draconitic.com/paper/99x3hswnw8yb9",
  "venue": "VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy",
  "versions": []
}