Laparoscopic-assisted percutaneous endoscopic transgastrostomy jejunostomy

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Neurology

Background:

• End-stage Parkinson disease management often involves continuous enteral carbidopa/levodopa administration.
• Percutaneous endoscopic transgastrostomy jejunostomy (PEG-J) is the typical method for jejunal access.
• Failed endoscopic transillumination is a contraindication for standard PEG-J placement.

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J).
• To establish enteric access for long-term medication delivery in patients with end-stage Parkinson disease when PEG-J fails.

Main Methods:

• A laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) was performed in patients who failed endoscopic transillumination.
• This minimally invasive procedure establishes jejunal access for pump-mediated medication delivery.

Main Results:

• Five patients with end-stage Parkinson disease underwent LAPEG-J after failed PEG-J attempts.
• Common reasons for failed transillumination included high stomach position or interposition of abdominal organs.
• The LAPEG-J procedure was uneventful in all patients, with no complications and early discharge.

Conclusions:

• Laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) is a viable and safe alternative.
• It provides a solution for jejunal access when standard endoscopic methods are unsuccessful.