title: Unsedated percutaneous endoscopic gastrostomy insertion: a safe, effective, and well-tolerated method.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) tube insertion is an uncomfortable procedure that has traditionally required sedation. In some patients, PEG tube insertion can be postponed or is not possible due to the risk of sedation. This article is a retrospective case series of 10 patients who have undergone unsedated peroral PEG tube insertion in the past 4 years at Stafford Hospital in the United Kingdom.
  
  
  METHODS
  Between 2006 and 2010, 10 patients who were identified by the nutrition team as needing a PEG tube underwent unsedated peroral PEG tube insertion. Patients were given pharyngeal anesthesia (lidocaine 1%), and the PEG tubes were inserted using the push-pull technique and local anesthesia. The procedures were performed without complications.
  
  
  RESULTS
  Those patients who were able to respond stated they would be willing to have the procedure performed again using this method. It was acceptable to them and not as unpleasant as they had expected.
  
  
  CONCLUSIONS
  This case series demonstrates that gastroenterology units without specialized equipment are able to safely insert PEGs in patients who are at increased risk for intravenous sedation.
authors.affiliation: Department of Gastroenterology, Stafford Hospital, Stafford, United Kingdom. helensteed@doctors.org.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Steed
authors.forename: Diane
authors.initials: D
authors.lastname: Barrett
authors.forename: Colin
authors.initials: C
authors.lastname: Emm
authors.forename: Wendy
authors.initials: W
authors.lastname: Lycett
authors.forename: Stephanie
authors.initials: S
authors.lastname: O'Toole
authors.forename: Kevin
authors.initials: K
authors.lastname: Evans
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Hearing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D061214:Patient Safety; D010614:Pharynx; D012189:Retrospective Studies; D012306:Risk; D006113:United Kingdom
chemical_list: D006993:Hypnotics and Sedatives; D008012:Lidocaine