Clinical and Economic Evaluation of Laparoscopically Assisted Percutaneous Endoscopic Gastrostomy Versus Open Gastrostomy in Patients for Whom Endoscopic Gastrostomy Is Difficult

Author(s):

Akira Kameyama

Background: Percutaneous endoscopic gastrostomy is a widely used technique for long-term enteral nutrition. However, some patients have anatomical or pathological conditions making standard percutaneous endoscopic gastrostomy infeasible. Traditionally, open gastrostomy has been performed in these cases, although it is more invasive. Laparoscopically Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) has recently been introduced as an alternative. This study aimed to compare the surgical outcomes and economic feasibility of LAPEG and open gastrostomy in patients with conditions that render standard percutaneous endoscopic gastrostomy unfeasible. Materials and methods: A retrospective review was conducted of all patients undergoing gastrostomy at our institution between January 2016 and February 2025. Among 378 total gastrostomies, sixteen were classified as “difficult”, meaning that endoscopic transillumination or the finger sign could not be confirmed, or preoperative imaging revealed organs overlapping the stomach. Data collected included operative time, blood loss, perioperative complications, and hospital economic outcomes based on Japan’s public insurance reimbursement. Statistical analyses were performed using t-tests, with statistical significance defined as P<0.05. Results: Sixteen patients were analyzed (four LAPEG and twelve open gastrostomy). Median operative times (49 min vs. 55.5 min) and blood loss (3.5 g vs. 5 g) did not differ significantly between the LAPEG and open groups, respectively. Three perioperative complications occurred in the open group (bowel pneumatosis in two patients and aspiration pneumonia in one), while none were observed in the LAPEG group. Although LAPEG incurred higher material costs and a significantly higher total hospital cost (162,138 yen vs. 145,053 yen, P=0.00365), the hospital’s gross profit was similar between groups (13,839 yen vs. 13,580 yen, P=0.606). Conclusion: Within the limitations of this small, retrospective study, LAPEG was comparable to open gastrostomy in terms of operative time and surgical outcomes. LAPEG showed higher material costs, but overall hospital profit remained similar. Large-scale, prospective investigations are warranted to validate these findings and further clarify the clinical and economic benefits of LAPEG in patients with difficult indications for percutaneous endoscopic gastrostomy.