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Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates
  1. Neil C Fisher,
  2. James Rees,
  3. John Frost
  1. Department of Gastroenterology, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK
  1. Correspondence to Dr Neil C Fisher, Department of Gastroenterology, Dudley Group of Hospitals NHS Foundation Trust, Dudley DY1 2HQ, UK; ncfisher{at}

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We wish to congratulate McCulloch et al on introducing the nuPEG approach in high-risk patients, such as those with neurodegenerative disorders.1 In turn, we recently adopted this approach but have adapted it to enable a faster procedural time, by using the pull-through technique rather than the Pexact technique described.

As described by McCulloch et al, the patient is semi-upright, with pharyngeal local anaesthesia but no sedation. Transnasal endoscopy is done, and for the PEG we use a conventional 15 Fr Freka PEG tubes with a retaining flange. With the endoscope in the stomach, the abdominal …

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  • Contributors NCF and JF discussed and agreed on the technique described. They agreed on the content of the letter. JR assisted in the procedures and collated outcomes. All authors reviewed and edited the letter.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.