Percutaneous gastrostomy without the need of endoscopy.

Patients who suffer from difficulty in performing simple and daily action – eating and drinking – often need a feeding tube inserted through the abdominal wall directly into the stomach. The difficulty in eating and drinking can arise from a wide range of clinical problems, such as tumors in the mouth/ esophagus/ muscular degeneration/ cerebral problems and more. Insertion of the feeding tube, called a gastrostomy, into the stomach is usually performed endoscopically using a gastroscope inserted into the stomach (PEG). However, there is often difficulty in performing the endoscopic operation. The difficulty arises from tumors in the neck that prevent the ability to transfer the gastroscope to the stomach. It can also arise in the context of breathing difficulties or patients who are unable to undergo an anesthetic procedure due to various risk factors.

Dr. Zeev Feuchtunger, director of the imaging department at Laniado Hospital, developed in Israel the method in which the tube is inserted into the stomach using X-ray reflection. The operation takes only about ten minutes, with minimal invasiveness under local anesthesia only, without the need for anesthesia or “blurring” (sedation) at all. The percutaneous method, which Dr. Feuchtunger performs, enables saving of the lives of those patients, who have given up on finding solutions to their condition, since in their clinical condition it was not possible to insert the tube into the stomach, neither with the endoscopic method nor with surgery. The meaning of not inserting the feeding tube into the stomach is a real danger to their lives due to malnutrition. So far, about 2000 operations have been performed at Laniado Hospital to insert the gastrostomy percutaneously with the use of X-ray. Patients from all over the country come to the imaging department at Laniado Hospital to perform the operation. About a year and a half ago, Laniado Hospital purchased a state-of-the-art CT machine, which allows performing X-ray scanning while the CT is being performed. This, in its turn, enables performing the operation even when it is not possible to insert a probe into the stomach.

• “Recently, an elderly patient in his 80s, a resident of Meitar in the south of Israel, came to me”, – says Dr. Feuchtunger. – “The patient suffered from a large lump in his neck and severe breathing problems because of which he was constantly connected to an oxygen generator. The patient was unable to put food in his mouth. It was not possible to perform the gastrostomy using the endoscopic method due to the large lump in the neck, and performing a surgical operation was out of the question, since he could not be anesthetized due to his respiratory condition. The patient began to lose weight and was desperate to find a solution to his condition. The patient came to Laniado, underwent insertion of the gastrostomy using the radiological percutaneous method, and his life was saved. He receives regular nutrition, and his body is slowly recovering from the malnutrition he suffered from”, – says Dr. Feuchtunger.

Prof. Zvi Shimoni, the medical director of Laniado Hospital, said: “We see the struggle for the life of each patient as a sacred task like no other. The method of inserting the percutaneous gastrostomy using the radiological method in cases where it cannot be performed by other methods, is a method performed exclusively at Laniado. We consider it our right to allow patients to receive feeding directly into the stomach, in situations where feeding cannot be performed in other ways”.