{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:15:42Z","timestamp":1782738942481,"version":"3.54.5"},"reference-count":21,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2017,11,19]]},"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Percutaneous endoscopic gastrostomy (PEG) tube placement is associated with a high risk of cardiorespiratory complications in patients with significant respiratory compromise. This study reports a case series of high-risk patients undergoing PEG placement using a modified technique\u2014nasal unsedated seated PEG (nuPEG) placement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective review of 67 patients at high risk of complications undergoing PEG placement between September 2012 and December 2016.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>UK specialist tertiary centre for clinical nutrition support.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>Patients underwent \u2018push\u2019 PEG placement using nasal endoscopy without sedation in a seated position.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Procedural success and tolerability, short term (within 24\u2009hours), medium term (24\u2009hours to 30 days) complications and survival were recorded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>67 patients underwent 68 nuPEG placements. The majority had motor neuron disease (46\/67). One patient developed a lower respiratory tract infection the following day. Two patients experienced accidental displacement of their PEG within 2 weeks. One patient died within 30 days of nuPEG insertion due to reasons unrelated to the procedure. Endoscopic comfort scores of 1 or 2 (98.0%) indicated good tolerance. A failure rate of 10.5% was attributed to intrathoracic displacement of the stomach, almost certainly due to the advanced stage of the neurological disease and associated diaphragmatic weakness.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our experience with the nuPEG technique suggests that it is safe and well tolerated in high-risk patients. As a result, it has now entirely supplanted radiologically inserted gastrostomy insertion in our institution and we recommend it as the method of choice for gastrostomy tube insertion in such patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/flgastro-2017-100894","type":"journal-article","created":{"date-parts":[[2017,12,5]],"date-time":"2017-12-05T20:40:26Z","timestamp":1512506426000},"page":"105-109","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates"],"prefix":"10.1136","volume":"9","author":[{"given":"Adam","family":"McCulloch","sequence":"first","affiliation":[{"name":"Cambridge Intestinal Failure and Transplant, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovishek","family":"Roy","sequence":"additional","affiliation":[{"name":"Colchester Hospital University NHS Foundation Trust, Colchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dunecan","family":"Massey","sequence":"additional","affiliation":[{"name":"Cambridge Intestinal Failure and Transplant, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Hedges","sequence":"additional","affiliation":[{"name":"Cambridge Intestinal Failure and Transplant, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Skerratt","sequence":"additional","affiliation":[{"name":"Cambridge Intestinal Failure and Transplant, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Wilson","sequence":"additional","affiliation":[{"name":"Cambridge Intestinal Failure and Transplant, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Woodward","sequence":"additional","affiliation":[{"name":"Cambridge Intestinal Failure and Transplant, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,12,5]]},"reference":[{"key":"2025090709470416000_9.2.105.1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181bc0141"},{"key":"2025090709470416000_9.2.105.2","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/j.1468-1331.2011.03501.x","article-title":"EFNS guidelines on the clinical management of ALS \u2013 revised report of an EFNS task force","volume":"19","author":"Anderson","year":"2012","journal-title":"Euro J Neurol"},{"key":"2025090709470416000_9.2.105.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(99)00045-3"},{"key":"2025090709470416000_9.2.105.4","unstructured":"National Confidential Enquiry into Patient Outcome and Death. 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