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

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.
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.
DISCUSSION AND CONCLUSION: PEG placement using a peroral route without sedation is a safe and well-tolerated method in patients with high sedation risk.