OC-112 Nupeg (nasal unsedated seated peg) is safer and better tolerated than rig (radiologically-inserted gastrostomy) in very high risk gastrostomy candidates

Introduction Endoscopic gastrostomy (PEG) placement in patients with severe respiratory or neuromuscular compromise carries a high risk of mortality through aspiration and radiological placement (RIG) is usually preferred in this setting. We have used ‘push-PEG’ placement in high risk patients guided by nasal endoscopy, unsedated and seated at 30–45° and here we report the outcomes of this technique compared to RIG placement in high risk patients. Method Records were analysed retrospectively for all ‘push-PEGs’ placed since 2008 and compared with records of RIG placements since 2010. Indications, completion rates and complications were compared. Results 296 push-PEGs have been placed since 2008 (mostly for head and neck malignancy). 242 were placed by standard per-oral endoscopic guidance and 54 using transnasal endoscopy using a Pentax transnasal endoscope. Of the 54, 27 (50%) were NuPEGs and the other 50% received intravenous sedation (SenPEG). 53/54 (98%) were placed successfully and without complication. One sedated patient experienced a respiratory arrest that required emergency intubation and led to the development of the NuPEG technique, since when no complications have been reported. From 2010–2014, 46 RIGs have been placed. Of these, 89% were successful and uncomplicated with one colonic perforation identified. In two patients where RIG failed due to anxiety or inability to lie flat, NuPEG was performed uneventfully. As a result, NuPEG has entirely replaced RIG in our institution where no RIGs have been placed since 2013. Conclusion NuPEG is safer and better tolerated than RIG in patients with respiratory or neuromuscular compromise and is the technique of choice in high risk patients requiring gastrostomy placement. Disclosure of interest None Declared.