Comparison of Sedated and Unsedated PEG in Elderly ASA IV Patients

Percutaneous endoscopic gastrostomy is commonly used to provide long-term enteral nutrition in patients who are unable to maintain adequate oral intake. Elderly patients with severe systemic disease and high anesthetic risk may be vulnerable to sedation-related cardiopulmonary adverse events. In some clinical settings, PEG can be performed using topical pharyngeal anesthesia and local anesthesia without systemic sedation.

This study will prospectively include elderly ASA IV patients undergoing PEG placement in routine clinical practice. Patients will be categorized into two cohorts according to the sedation strategy used during the procedure: unsedated PEG and sedated PEG. The sedation strategy will not be assigned by the investigators and will be determined according to routine clinical assessment, patient condition, and anesthesiology evaluation when required.

The study will compare cardiopulmonary complications within 24 hours, technical success, procedure-related complications, and 30-day clinical outcomes between the two cohorts.

Inclusion criteria

• Patients aged 65 years and older Patients classified as ASA physical status IV Patients with an indication for percutaneous endoscopic gastrostomy for long-term enteral nutrition Patients scheduled to undergo PEG placement in routine clinical practice Written informed consent obtained from the patient or legally authorized representative Availability of clinical, laboratory, procedural, and follow-up data

Exclusion criteria

• Requirement for emergency PEG placement International normalized ratio greater than 1.5 Platelet count less than 50,000/mm³ Massive ascites Active peritonitis Previous total gastrectomy Pregnancy Refusal to participate in the study