title: Unsedated transnasal percutaneous endoscopic gastrostomy placement in selected patients.
abstract: OBJECTIVE
  The placement of a percutaneous endoscopic gastrostomy (PEG) is the procedure of choice for the long-term management of dysphagic patients with neurological disease or with trauma or tumors of the head and neck. It is not always possible to perform conventional upper gastrointestinal endoscopy in such patients due to stenosis and/or occlusion of the mouth or pharynx and/or partial or complete trismus. The aim of this study was to show whether transnasal esophagogastroduodenoscopy (EGD) offers a feasible and effective alternative method for PEG placement in these selected patients.
  
  
  METHODS
  PEG placement was required for 155 patients at our institution during a 27-month period. In 12 patients oral access of an endoscope into the esophagus was not possible. Unsedated transnasal EGD (T-EGD) was then performed using an ultrathin video gastroscope, which had a distal-end diameter of 5.9 mm. A 16-Fr polyurethane PEG tube with a conical, flexible, soft distal end and a collapsible bumper was used in all cases. The Gauderer-Ponsky pull technique was used for PEG placement.
  
  
  RESULTS
  T-EGD and perendoscopic transnasal placement of a PEG tube was successfully performed in all 12 patients. No patient required sedation during the procedure. No immediate or late-onset procedure-related complications occurred in any of the 12 patients.
  
  
  CONCLUSIONS
  In some dysphagic patients in whom the oral route is not accessible with a standard endoscope, a transnasal endoscopic approach allows the placement of a PEG tube. In these selected patients this technique has been shown to be safe and effective and does not require the use of sedation.
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Vitale
authors.forename: G
authors.initials: G
authors.lastname: Villotti
authors.forename: L
authors.initials: L
authors.lastname: D'Alba
authors.forename: M A
authors.initials: MA
authors.lastname: De Cesare
authors.forename: S
authors.initials: S
authors.lastname: Frontespezi
authors.forename: G
authors.initials: G
authors.lastname: Iacopini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System; D004750:Enteral Nutrition; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D020699:Gastroscopes; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D044342:Malnutrition / Q000628:therapy; D008875:Middle Aged; D020535:Video-Assisted Surgery