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.
Dr Vitale and colleagues from Rome, Italy undertook a study in order to show whether transnasal esophagogastroduodenoscopy (EGD) offers a feasible and effective alternative method for PEG placement in these selected patients.
Percutaneous endoscopic gastrosomy 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.
|Clinicians successfully performed T-EGD and perendoscopic transnasal placement of a PEG tube in all 12 patients|
The researchers then performed unsedated transnasal EGD (T-EGD) using an ultra-thin video gastroscope, which had a distal-end diameter of 5.9 mm.
The investigators used a 16-Fr polyurethane PEG tube with a conical, flexible, soft distal end and a collapsible bumper in all cases.
The Gauderer-Ponsky pull technique was used for PEG placement.
The clinicians were able to successfully perform T-EGD and perendoscopic transnasal placement of a PEG tube in all 12 patients.
No patient required sedation during the procedure.
The researchers noted that no immediate or late-onset procedure-related complications occurred in any of the 12 patients.
Dr Vitale concluded, "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."