Transnasal percutaneous endoscopic gastrostomy (T-PEG): a case series of push and pull-through T-PEGs in high-risk groups

Background Percutaneous Endoscopy Gastrostomy (PEG) insertion is a long-established intervention in neurodegenerative diseases and aerodigestive malignancies where enteral feeding is required. Transnasal PEG (T-PEG) has been advocated as a safer alternative compared with conventional transoral PEGs for selected patients, although large case series are lacking in the literature. (1,2) This case series illustrates technique and outcomes for two types of T-PEG procedures; firstly, the using a modified ‘pull-through’ technique and secondly using a gastropexy-assisted ‘push’ technique Methods Our practice is to use pull-through T-PEGs predominantly for high-risk patients with neurodegenerative disease, and push T-PEGs for patients with aerodigestive malignancies. Patient selection is carried out by a clinical nutrition multidisciplinary team (MDT). The techniques used for both pull-through T-PEG techniques are described. A prospective database of T-PEG cases was analyzed to evaluate outcomes. Results A total of 55 T-PEG procedures were completed between 2018 and 2024. There were 27 cases of primary neurodegenerative diseases and 21 cases of aerodigestive cancer (remaining 7 cases, miscellaneous). All but one T-PEG was successful at first attempt and with no serious procedural complications. There was one readmission with self-limiting insertion site pain, and 30-day mortality was 1/55 (a cancer case). Conclusions In our case series of T-PEGs, we have demonstrated a high procedural success rate and low complication and mortality rates. T-PEG can be considered a viable alternative for patients who are not suitable candidates for traditional PEG and a valid alternative to other options such as radiological or surgical gastrostomy.