Combined laparoscopic and endoscopic technique for safe percutaneous endoscopic gastrostomy in a patient with challenging abdominal anatomy.
- 1Institute of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel.
- 2Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- 3General Surgery Department, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Abstract
Background and aims
PEG 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
We 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
Enteral feeding began the same day, and recovery was uneventful. Laparoscopic-assisted PEG enabled safe gastrostomy placement after multiple failed approaches.Conclusions
Laparoscopic-assisted PEG is a minimally invasive alternative that avoids the morbidity of formal surgical gastrostomy when PEG or radiologic interventional gastrostomy are not feasible.
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BibTeX
@article{hakimian2026combined,
title = {{Combined laparoscopic and endoscopic technique for safe percutaneous endoscopic gastrostomy in a patient with challenging abdominal anatomy.}},
author = {David Hakimian and Anat Hershko Moshe and Joshua Zev Gottesman and Briggite Helou and Gad Marom},
journal = {VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy},
year = {2026},
month = may,
doi = {10.1016/j.vgie.2026.05.002},
url = {https://europepmc.org/article/MED/42923296},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Combined laparoscopic and endoscopic technique for safe percutaneous endoscopic gastrostomy in a patient with challenging abdominal anatomy.
AU - David Hakimian
AU - Anat Hershko Moshe
AU - Joshua Zev Gottesman
AU - Briggite Helou
AU - Gad Marom
PY - 2026
DA - 2026/05/18
JO - VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy
DO - 10.1016/j.vgie.2026.05.002
UR - https://europepmc.org/article/MED/42923296
AB - Background and aims PEG 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 We 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 Enteral feeding began the same day, and recovery was uneventful. Laparoscopic-assisted PEG enabled safe gastrostomy placement after multiple failed approaches.Conclusions Laparoscopic-assisted PEG is a minimally invasive alternative that avoids the morbidity of formal surgical gastrostomy when PEG or radiologic interventional gastrostomy are not feasible.
SN - 2468-4481
ER -