Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates

McCulloch, Adam; Roy, Ovishek; Massey, Dunecan; Hedges, Rachel; Skerratt, S.; Wilson, Nicola; Woodward, Jeremy

doi:10.1136/flgastro-2017-100894

Cited by 7 publications

(9 citation statements)

References 19 publications

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“…Of those patients who underwent a successful TNE procedure, 98.1% achieved D2 intubation and all successfully performed a retroflexion procedure (table 2). Inlet patch detection was 5.7% and comparable with the background rate 12…”

Section: Our Experiencesupporting

confidence: 59%

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Transnasal endoscopy: moving from endoscopy to the clinical outpatient–blue sky thinking in oesophageal testing

Lim

Haboubi

Anderson

et al. 2022

Frontline Gastroenterol

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BackgroundCOVID-19 has severely affected UK endoscopy services with an estimate 86% loss of activity during the first wave. Subsequent delays in diagnostic and surveillance procedures highlight the need for novel solutions to tackle the resultant backlog. Transnasal endoscopy (TNE) provides an attractive option compared with conventional upper gastrointestinal endoscopy given its limited use of space, no sedation and reduced nursing resources.Our experienceWe describe piloting and then establishing an outpatient model TNE service in the pandemic era and the implications on resource allocation, training and workforce. We also discuss our experiences and outline ways in which services can evolve to undertake more complex endoscopic diagnostic and therapeutic work. Over 90% of patients describe no discomfort and those who have previously experienced conventional transoral endoscopy preferred the transnasal approach. We describe a low complication rate (0.8%) comprising two episodes of mild epistaxis. The average procedure duration was reasonable (9.9±5.0 min) with full adherence to Joint Advisory Group quality standards. All biopsies assessed were deemed sufficient for diagnosis including those for surveillance procedures.DiscussionTNE can offer a safe, tolerable, high-quality service outside of a conventional endoscopy setting. Expanding procedural capacity without impacting on the current endoscopy footprint has great potential in recovering endoscopy services following the COVID-19 pandemic. Looking forward, TNE has potential to be used both within the endoscopy suite as part of therapeutic procedures, or outside of the endoscopy unit in outpatient clinics, community hospitals, or mobile units and to achieve this in a more sustainable and environmentally friendly way.

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Section: Our Experiencesupporting

confidence: 59%

“…Therapeutic options for TNE include the potential for procedures to support the nutrition of complex or high-risk patients such as a TNE approach for NJ tube insertion24 or PEG placement through either a direct puncture (Pexact) or pull-through technique 12…”

Section: Discussionmentioning

confidence: 99%

Transnasal endoscopy: moving from endoscopy to the clinical outpatient–blue sky thinking in oesophageal testing

Lim

Haboubi

Anderson

et al. 2022

Frontline Gastroenterol

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“…An oral approach is still favored when therapy or hemostasis is likely to be required, although, as technology continues to advance and further evidence emerges [7], there is an increasing role for therapeutic TNE (such as for strictures [16], percutaneous endoscopic gastrostomy [17][18][19] and feeding tube placement [20], endoscopic submucosal dissection [21,22] and Botulinum toxin (Botox) injections [23]). Recent studies have also explored the use of uTNE in the pre-screening of bariatric surgery patients, with results suggesting that it is a well-tolerated examination and is an appropriate choice in morbidly obese patients due to minimal cardiovascular stress being induced [24,25].…”

Section: Technological Advancesmentioning

confidence: 99%

Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy

et al. 2022

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Diagnostic unsedated transnasal endoscopy (uTNE) has been proven to be a safe and well-tolerated procedure. Although its utilization in the United Kingdom (UK) is increasing, it is currently available in only a few centers. Through consideration of recent studies, we aimed to perform an updated review of the technological advances in uTNE, consider their impact on diagnostic accuracy, and to determine the role of uTNE in the COVID-19 era. Current literature has shown that the diagnostic accuracy of uTNE for identification of esophageal pathology is equivalent to conventional esophagogastroduodenoscopy (cEGD). Concerns regarding suction and biopsy size have been addressed by the introduction of TNE scopes with working channels of 2.4 mm. Advances in imaging have improved detection of early gastric cancers. The procedure is associated with less cardiac stress and reduced aerosol production; when combined with no need for sedation and improved rates of patient turnover, uTNE is an efficient and safe alternative to cEGD in the COVID-19 era. We conclude that advances in technology have improved the diagnostic accuracy of uTNE to the point where it could be considered the first line diagnostic endoscopic investigation in the majority of patients. It could also play a central role in the recovery of diagnostic endoscopic services during the COVID-19 pandemic.

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“…No documented complication was found in the remaining patient group during the procedure. [17] In our study, comfort of the patients during the procedure was recorded by the endoscopy nurse using the Modified Gloucester Comfort Scale and no discomfort or minimal discomfort was observed in 67.2% (n=33) of the patients.…”

Section: Discussionmentioning

confidence: 95%

Percutaneous endoscopic gastrostomy placement without sedation in high-risk patients: A safe and well-tolerated technique

Gul¹

2020

Laparosc Endosc Surg Sci

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Introduction: Percutaneous endoscopic gastrostomy (PEG) is regarded as the standard enteral feeding procedure for patients requiring long-term enteral nutrition. Although it is considered as a safe procedure, PEG may be associated with severe cardiorespiratory complications, especially in patients with sedation-induced respiratory compromise. This article is a retrospective analysis of 49 patients at high-risk of complications, who undergone unsedated peroral PEG tube placement.Materials and Methods: PEG was placed in 49 patients through the peroral endoscopic way without sedation. The patients were given pharyngeal anesthesia and the PEG tubes were inserted using the 'pull ' technique. The comorbidities, PEG indications, pharyngeal anesthesia indications, arterial oxygen saturations throughout the procedure, the comfort and the tolerability score and complications were recorded.Results: Of all patients 27 (55.1%) were female and 22 (44.9%) were male. The mean age of the patients was 81 (range: 33-99) years. PEG procedure was performed due to the loss of swallowing reflex and dysphagia in 24 (48.9%), replacement of the previously inserted PEG tube in 11 (22.5%), malnutrition in 9 (18.3%) and nasogastric tube intolerance in 5 (10.2%) patients. Unsedated procedure was performed due to aspiration pneumonia in 21 (42.8%), chronic pulmonary disease in 10 (20.4%), request from patient relatives in 15 (30.6%), and on patient's own request in 3 (6.1%). Modified Gloucester Comfort Scale was used to evaluate the comfort and the tolerability of the patients. According to the scale, 24.4% of the patients showed no signs of discomfort, 42.8% showed mild signs of discomfort yet well tolerated the procedure. Only 8.1% showed significant discomfort. As complications, tube dislodgement was observed in 3 patients and wound infections were recorded in 4 patients. Conclusion:PEG placement using a peroral route without sedation is a safe and well-tolerated method in patients with high sedation risk.

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Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates

Cited by 7 publications

References 19 publications

Transnasal endoscopy: moving from endoscopy to the clinical outpatient–blue sky thinking in oesophageal testing

Transnasal endoscopy: moving from endoscopy to the clinical outpatient–blue sky thinking in oesophageal testing

Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy

Percutaneous endoscopic gastrostomy placement without sedation in high-risk patients: A safe and well-tolerated technique

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