Laparoscopic Gastrostomy

As physicians with a keen interest in gastrostomy, we were interested to read about Raakow and colleagues' experience with laparoscopic gastrostomy [ 1 ], but we were surprised by the inexplicable absence from their discussion of radiologic gastrostomy as a viable option for feeding tube placement. Radiologists in our department have been performing fluoroscopically guided gastrostomy and gastrojejunostomy on an almost daily basis for the last 17 years. Even if radiologic gastrostomy is unavailable to Raakow et al., we believe that it warrants inclusion in their discussion. Most importantly, we strongly disagree with the authors' assertion that an inability to pass an endoscope makes surgical gastrostomy mandatory. Radiologic techniques easily cross strictures that do not permit passage of endoscopes. Furthermore, passage of an orogastric or nasogastric tube is not necessary for safe and successful radiologic gastrostomy [ 2 ]. Radiologic gastrostomy, performed under local anesthesia, is effective and successful, with safety equal to or greater than endoscopic gastrostomy [ 3 ] [ 4 ] [ 5 ] [ 6 ]. Laparoscopic techniques are not as safe. Invasive techniques such as surgery or laparoscopy cannot be justified for gastrostomy alone.