Unsedated Percutaneous Endoscopic Gastrostomy Insertion: A Safe, Effective, and Well-Tolerated Method

Background: Percutaneous endoscopic gastrostomy (PEG) tube insertion is an uncomfortable procedure that has traditionally required sedation. In some patients, PEG tube insertion can be postponed or is not possible due to the risk of sedation. This article is a retrospective case series of 10 patients who have undergone unsedated peroral PEG tube insertion in the past 4 years at Stafford Hospital in the United Kingdom. Methods: Between 2006 and 2010, 10 patients who were identified by the nutrition team as needing a PEG tube underwent unsedated peroral PEG tube insertion. Patients were given pharyngeal anesthesia (lidocaine 1%), and the PEG tubes were inserted using the push-pull technique and local anesthesia. The procedures were performed without complications. Results: Those patients who were able to respond stated they would be willing to have the procedure performed again using this method. It was acceptable to them and not as unpleasant as they had expected. Conclusions: This case series demonstrates that gastroenterology units without specialized equipment are able to safely insert PEGs in patients who are at increased risk for intravenous sedation. (JPEN J Parenter Enteral Nutr. 2012;36:231-234)