Background: Several cases of successful percutaneous endoscopic gastrostomy (PEG) through the transnasal route have been reported, and Pseudomonas aeruginosa infection in transnasal PEG was described earlier. This study was conducted to investigate the difference between transnasal PEG and conventional PEG. Methods: A retrospective caseecontrol study was conducted to compare pull-type transnasal (T-PEG) and peroral (O-PEG) placement of a 20 Fr PEG tube in a community hospital. Thirtyeight T-PEG and 38 O-PEG were analyzed in 76 chronic dysphagic patients from homes or nursing homes. The operating time, occurrence of choking during PEG, stomal site infection, bacterial pathogens, and post-PEG complication were recorded and analyzed. Results: The mean age was 76.3 AE 10.3 years for T-PEG versus 79.3 AE 6.9 years for O-PEG; 67% were male versus 48% female; operating time was 14.6 AE 4.0 minutes for T-PEG versus 11 AE 3 minutes for O-PEG (p Z 0.0028), and choking occurred in three patients in the T-PEG group versus five in the O-PEG group. There were 10 stomal site infections (9 with P. aeruginosa) in the T-PEG group and 14 (8 with P. aeruginosa) in the O-PEG group (p < 0.001). One systemic infection of the urinary tract, one buried bumper, and one stomal soiling were observed in the T-PEG and O-PEG groups. No PEG-related mortality occurred within 3 months after all PEG procedures. Conclusion: Transnasal insertion of PEG using a pull method is a feasible and safe alternative when conventional pull-method PEG is not possible. However, P. aeruginosa infection is Advances in Digestive Medicine (2015) xx, 1e5 common when using T-PEG; therefore, more studies focusing on prophylaxis of T-PEG-associated P. aeruginosa infection are required.

The use of a homemade balloon dilator and protector hood composed of condoms for assisting the removal of sharp foreign bodies lodged in the upper esophagus in difficult cases is reported. A conventional endoscopic method failed to remove two sharp bones and two press-through packages became impacted in the upper esophagus. A condom was used to make a balloon dilator that was attached to a flexible endoscope in an attempt to dilate the upper esophageal sphincter to dislodge the impacted sharp bones. This handmade condom balloon dilator succeeded in dislodging the two tightly impacted sharp bones and assisted in removing the impacted objects in the upper esophagus. Additionally, a condom was tied to the distal end of the scope to act as a protector hood to protect the esophageal mucosa when removing the sharp packages. The two impacted press-through packages were pushed into the lower esophagus or stomach and removed uneventfully using the condom protector hood. Subsequent endoscopy disclosed no relevant mucosal damage after the successful removal and the patients did well after discharge from the emergency department. In conclusion, condombased endoscopic balloon dilatation is a simple and accessible method for assisting the endoscopic removal of tightly impacted, sharp foreign bodies in the upper esophagus. A condom can also be used as a protector hood to avoid mucosal injury when removing impacted, sharp pressthrough packages when a commercial protector hood is not available.