Unsedated transnasal PEG placement
Section snippets
Patients and methods
A forward-viewing “pediatric” videoendoscope was used for all procedures (GIF-XP160; Olympus Optical Co., Ltd., Tokyo, Japan). This endoscope has the following characteristics: outer diameter, 5.9 mm; air/water and accessory channel diameter, 2 mm; depth of field, 3 to 100 mm; working length, 1030 mm; field of view, 120°; and tip flexion, 180° up, 90° down, 100° left and right.
All procedures were performed by senior endoscopists with experience in transnasal EGD. Topical anesthesia is induced
Results
Transnasal insertion of PEG was attempted in 23 patients (12 men, 11 women; median age, 63 years; range 46–91 years). The indications for PEG placement were stroke (n = 9, 39%); dementia, with refusal to eat (n = 8, 35%); and oropharyngeal obstructive malignancy, with or without trismus (n = 6, 26%). No patient was undergoing mechanical ventilation. Transnasal PEG placement was successful in 21 (91%). The reason for failure in two patients was the inability to transilluminate the stomach. A PEG was
Discussion
Transnasal EGD originally was regarded as an alternative procedure when transoral intubation was impossible or the patient was unable to tolerate transoral insertion of an endoscope.14., 15. The feasibility of transnasal EGD with small-diameter endoscopes is well established, and this technique offers certain theoretical advantages. It was demonstrated by us that the increased patient tolerance is related to the transnasal route and not the smaller diameter of the endoscope.12 The patient can
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Cited by (49)
Pediatric Unsedated Transnasal Endoscopy
2023, Gastrointestinal Endoscopy Clinics of North AmericaSmall-Caliber Endoscopy
2019, Clinical Gastrointestinal EndoscopyCombined endoscopic gastrostomy ("Pull-Introducer Technique"): A new less traumatic technique for preterm and small for gestational age patients
2016, Journal of Pediatric SurgeryCitation Excerpt :We also use it when we need to avoid the passage of the internal bumper through the esophagus in cases with epidermolisis bullosa, esophageal stenosis, or esophageal varices. In adults we have used this method in patients with head and neck cancer, when we need to reduce contamination and when we perform a transnasal gastrostomy [13]. We hope this method will allow us to install a primary button, reducing costs and procedures.
Advances in nutritional delivery interventions
2015, Techniques in Gastrointestinal EndoscopyTransnasal PEG tube placement in patients with head and neck cancer
2014, Gastrointestinal EndoscopyCitation Excerpt :Since then, many additional case reports and case series have been described.16-24 The indication for the transnasal approach in those reports include severe trismus because of neurologic disorders, oropharyngeal obstruction secondary to H&NCa, dental misalignment, maxillary fractures, and postsurgical changes.16-24 Compared with those cases, all of our patients had H&NCa, and the indications for the transnasal route were either malignancy-associated obstruction, trismus, recent head and neck surgery, and hypopharyngeal ulceration.
Effect of the introducer technique compared with the pull technique on the peristomal infection rate in PEG: A meta-analysis
2012, Gastrointestinal EndoscopyCitation Excerpt :The analyzed techniques were the pull technique proposed by Gauderer et al1 and the many variations of the introducer technique (eg, progressive dilatation proposed by Russell et al,9 the use of a metal trocar,10,16 or the use of a radially expandable trocar17,18). Studies that used the technique proposed by Sacks et al19 or transnasal access were excluded.20 All studies in which gastrostomy was performed by using conventional surgery, laparoscopic surgery, or radiologic methods were excluded.