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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}btinternet.com

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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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