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Transoral percutaneous endoscopic gas− trostomy (PEG) is not possible in some pa− tients due to difficulty in opening the mouth (e.g., in patients with head and neck cancers, oral submucous fibrosis, dental misalignment, and intermaxillary fixation). Transnasal endoscopy has been used for diagnostic upper gastrointestinal endoscopy and for placement of enteral feeding tubes [1, 2]. However, the small diameter of the accessory channel in transnasal instruments (2 mm) limits their use for therapeutic interventions [3]. A study of transnasal percutaneous endoscopic gastrostomy (TN−PEG) using pediatric scopes (with an outer diameter of 7.9 mm) reported failure of the method in three of six patients [4]. TN−PEG using standard−diameter endoscopes has been reported [5].

Transnasal Percutaneous Endoscopic Gastrostomy Using a Standard-Diameter Gastroscope (9.8 mm)