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: 3399) 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 patients 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.