Safety and feasibility of unsedated peroral percutaneous endoscopic gastrostomy placement in both outpatient and inpatient settings

Abstract

Percutaneous endoscopic gastrostomy (PEG) is traditionally performed under sedation. However, sedation is often associated with cardiopulmonary risks. Unsedated PEG placement may be an alternative in patients with a high anesthesia risk. However, there are only a few studies in the literature on the feasibility of oral unsedated PEG placements. Additionally, there are conflicting results in the literature regarding whether PEG placement increases mortality in hospitalized patients. The primary aim of this study was to investigate the safety and feasibility of peroral PEG placement without sedation in our surgical endoscopy unit. Secondly, we aimed to compare the mortality and morbidity results of unsedated PEG placements in inpatients (IP) and outpatients (OP). The medical records of patients who underwent peroral unsedated PEG placements in our surgical endoscopy unit between September 2019 and September 2022 were reviewed retrospectively. The patients were divided into two groups: inpatients (IP) and outpatients (OP). Demographic data, PEG indications, comorbidities, procedural success rate, PEG-related complications, and 30-day mortality data were analyzed. A total of 312 patients were included in the study, with a median age of 79 years (interquartile range (IQR): 70-86). The overall PEG-related complication rate was 9.2%, and the 30-day mortality rate was 5.1%. The procedure success rate was 99%. There were no statistically significant differences between the groups in terms of PEG indications, PEG-related complications, and mortality (p=0.430, p=0.384, and p=0.437, respectively). This study demonstrates that unsedated PEG placement using the conventional peroral route is a safe and feasible procedure, regardless of the indications. Also, the PEG procedures can be performed safely on outpatients without increasing complications. Furthermore, the study findings suggest that inpatient PEG placement does not lead to increased mortality rates compared to outpatient PEG placement.

Keywords

• Percutaneous endoscopic gastrostomy
• unsedated
• peroral
• inpatient
• outpatient
• mortality

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