Unsedated transnasal PEG placement

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Abstract

Background

By using a small-diameter endoscope, EGD can be performed transnasally in adults. A prospective study was conducted to evaluate the feasibility of transnasal PEG placement without conscious sedation.

Methods

Unsedated transnasal PEG was attempted in 23 patients by using a 5.9-mm-diameter videoendoscope. The indication for PEG insertion, success or failure, reason(s) for failure, and adverse effects of the procedure were recorded. During the first month, all patients were monitored by telephone contact for complications and to verify functionality of the PEG.

Results

Transnasal PEG insertion was successful in 21 (91%) patients. The cause for failure was the inability to transilluminate the abdominal wall. Complications included epistaxis (n = 1), minor wound infection (n = 1), and soiling around the stoma (n = 1). Of the 21 patients in whom transnasal PEG placement was successful, all were alive, with a functional gastrostomy at the 1-month follow-up.

Conclusions

Unsedated transnasal PEG tube insertion is minimally invasive, is feasible in daily practice in selected patients, and rarely is associated with complications.

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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