Laparoscopic Janeway gastrostomy as preferred enteral access in specific patient populations: A systematic review and case series

Table 1 2010 American association of clinical endocrinologists protocol for production of clinical practices guidelines - evidence rating

Numerical descriptor (evidence level)	Semantic descriptor (reference methodology)
1	Meta-analysis of randomized controlled trials
1	Randomized controlled trial
2	Meta-analysis of nonrandomized prospective or case-controlled trials
2	Nonrandomized controlled trial
2	Prospective cohort study
2	Retrospective case-control study/Retrospective cohort study
3	Cross-sectional study
3	Surveillance study (registries, surveys, epidemiologic study)
3	Consecutive case series
3	Single case reports
4	No evidence (theory, opinion, consensus, or review)

1 = strong evidence; 2 = intermediate evidence; 3 = weak evidence; 4 = no evidence. CCS: Consecutive case series; CSS: Cross-sectional study; MRCT: Meta-analysis of randomized controlled trials; MNRCT: Meta-analysis of nonrandomized prospective or case-controlled trials; NRCT: Nonrandomized controlled trial; NE: No evidence; PCS: Prospective cohort study; RCCS: Retrospective case-control study; RCS: Retrospective cohort study; RCT: Randomized controlled trial; SS: Surveillance study; SCR: Single case reports.

Table 2 Literature reported cases of laparoscopic Janeway gastrostomies

Ref.	Evidence rating	Case	Outcomes	Complications
Haggie et al[18], 1992	3	n = 1 pt; Age= 65 yr (M); Esophageal occlusion of pharyngeal SCC s/p CTX and RTX	ORT: N/M; MUTs: 3 wk (death 2/2 primary disease)	Leakage of gastric contents easily managed; D: 1; R: 1; TC: 2
Serrano et al[13], 1994	3	n = 7 pt; Age = 48-83 yr; Esophageal cancer stage IV: 85% (n = 6); Traumatic peri-esophageal hematoma: 14.2% (n = 1)	ORT: 30-40 min. Average 35 min. MUTs: N/M	TC: 0; D: 0; R: 0; Mortality: 0
Ritz et al[12], 1998	3	n = 15 pt; Age average: 61 yr; Esophageal or paraesophageal tumors	ORT: 20-55 min. MUTs: 3.5 mo (death)	Stoma necrosis to Witzel gastrostoma: 6.6% (n = 1); Self-limiting skin irritation: 20% (n = 3); D: 0; R: 0; TC: 2
Molloy M et al[17], 1997	3	n = 2 pt (M); Age= 63 yr and 77 yr; Organic neurologic disorders + pulled out PEG (placed 48 h prior); Perforation along greater curvature (minimal contamination)	ORT: N/M. MUTs: N/M	C: N/M; D: N/M; R: N/M
Raakow et al[14], 2001	2	n = 21 pt (19 M; 2 F); Age = 53-78 yr; Extensive tumors of: Hypopharynx 57.1% (n = 12) Esophagus 42.8% (n = 9); Prior UGI surgery 19% (n = 4) to (2 OCh, 1 PCJ, 1 repair DP)	ORT: 24-50 min. Average 38 mins. MUT: 3.4 mo 2/2 death due to primary	C: Self-limiting skin irritation (method dependent): 9.6% (n = 2); D: N/M; R: N/M; Mortality from advanced cancer; MUTs: 26 d to 6.5 mo (average 3.4 mo)
Tous Romero et al[19], 2012	2	n = 57 pt; Age = 51 yr; 10 LJG, 47 OJG; Esophageal cancer: 38.6% (n = 22); Head & neck: 26.3% (n = 15); Neuro deficit 26.3% (n = 15)	ORT: N/M. MUTs: N/M	TC: 5 (some patients had multiple complications); D: N/M; R: N/M; Gastric content leakage: 30% (n = 3); Abd wall irritation: 30% (n = 3); No C: 50% (n = 5); Exudate: 10% ( n = 1); Exudate with + culture: 20% ( n = 2); Granuloma: 10%( n = 1); Balloon rupture: 10% (n = 1); Loss of peristomal content: 0

C: Complications; CXT: Chemotherapy; D: Dislodgement; DPr: Duodenal perforation; F: Female; M: Male; GT: Gastric tube; LJG: Laparoscopic Janeway gastrostomy; JT: Jejunostomy tubes; LE: Life expectancy; MUTs: Mean usage times; n: Number of patients; N/M: Not mentioned; OCh: Open cholecystectomy; ORT: Operating time; Pt: Patients; PCJ: Pancreatic cyst jejunostomy; R: Replacement; RXT: Radiotherapy; SG: Stamm gastrostomy; SCC: Squamous cell carcinoma; UGI: Upper gastrointestinal.

Table 3 Literature reported cases of open gastrostomies

Ref.	Evidence rating	Case	Outcomes	Complications
McGovern et al[21], 1984	3	n = 14 children (> 7lb); Severe cerebral palsy without pharyngeal musculature coordination and risk of aspiration	ORT: N/M, MUTs: N/M	C: GT stenosis treated with dilation: 7.14% (n = 1); Stomal granulations treated with cautery: 7.14% (n = 1); Mortality: 0; D: N/M; R: N/M
Laughlin et al[20], 1989	3	n = 5 pt. Advanced esophageal cancer; Age/gender: N/M	ORT/MUTs: N/M	C: Stomal tip necrosis with stomal stenosis: 20% (n = 1); Mortality: 0; D: N/M; R: N/M
Vassilopoulos et al[11], 1998	3	n = 24 pt (21M; 3F); Age average: 67.19 yr; Advanced head/neck cancer; Advanced UGI malignancy: 1.2% (n = 5); Prior UGI surgery: 0.48% (n = 2)	ORT: < 40 min; MUTs: N/M	C: Midline wound SSI treated with antibiotics: 16.6% (n = 4); Mortality: 0; D: N/M; R: N/M
Koivusalo et al[15], 2006	33	n = 4 pt; Age = 0-6 yr; Recurrent gastrostomy prolapses and peristomal infection undergoing modified OJG revision; 3: OSG to 2 closure + PEG; 1: Initial PEG; Prior abdominal surgeries (OGT/PEG)	MUTs: 9 mo	C: 0;D: N/M; R: N/M content
Abdel-Lah et al[16], 2006	3	Total procedure 287: JT: 46% (n = 167); SG: 18% (n = 40); OJG: 4% (n = 8); SNY double lumen: 32% (n = 72); Head & neck cancer; Total permanent gastrostomies n = 27: Balloon catheter/Fontan (LE < 37 d): n = 19; OJG (LE > 6 mo): n = 8	MUTs; JG = 164 d	Morbidity 12.5% (n = 5): D (Migration)/peristomal abrasion- no fixation to parietal peritoneum; Mortality (open jejunostomy) 4.2% (n = 12); Esophageal 3% ( n = 9); Esophagojejunal: 1.2% (n = 3); R: N/M
Tous Romero et al[19], 2012	2	n = 57 pt; Age average: 57, 51 yr 10 LJG, 47 OJG; Esophageal cancer: 38.6% (n = 22); Head & neck: 26.3% n = 15); Neuro deficit: 26.3% (n = 15)	ORT/MUTs: N/M	Gastric content leakage: 89.4% (n = 42); Abd wall irritation: 83% (n = 39); No C: 2.1% (n = 1); Exudate: 23.4% (n = 11); Granuloma: 4.3% (n = 4); Balloon rupture: 21.3% (n = 10); Loss of peristomal content: 17% (n = 8)

C: Complications; CXT: Chemotherapy; D: Dislodgement; DPr: Duodenal perforation; F: Female; M=Male; GT: Gastric tube; GC: Great curvature; LJG: Laparoscopic Janeway gastrostomy; JT: Jejunostomy tubes; LE: Life expectancy; MUTs: Mean usage times; n: Number of patients; N/M: Not mentioned; OCh: Open cholecystectomy; OJG: Open Janeway gastrostomy; ORT: Operating time; Pt: Patients; OSG: Open stamm gastrostomy; PCJ: Pancreatic cyst jejunostomy; R: Replacement; RXT: Radiotherapy; SG: Stamm gastrostomy; SCC: Squamous cell carcinoma; SSI: Surgical site infection; UGI: Upper gastrointestinal.

Table 4 Our case series of post coronavirus disease 2019 era

Case	Selection of LJG vs others	Indications	Outcomes	Complications
Patient A: 77 yr female	Instead of PEG; Patient is high risk of pulling out tubes	Worsening dementia and AMS. Need for long term/permanent feeding	ORT: 87 min. MUTs: 3 mo	D: 0; R: 0; TC: 0
Patient B: 58 yr male; s/p tracheostomy and recent PEG tube placement	Instead of PEG. C: Dislodgement of PEG and septic shock	Cerebral palsy, seizure disorder self-removed PEG. Prior PEG removal + replacement	ORT: 76 min. MUTs: 3 mo	D: 0; R: 0; TC: 0

LJG: Laparoscopic Janeway gastrostomy; PEG: Percutaneous endoscopic gastrostomy; D: Dislodgement; R: Replacement; C: Complications; N/M: Not mentioned; MUTs: Mean usage times; ORT: Operating time.