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Introduction Percutaneous endoscopic gastrostomy (PEG) is an alternative and important way to maintain nutrition. Trans-nasal PEG insertion (t-PEG) using small-calibre endoscope has been reported to be safe and effective than the conventional trans-oral PEG (o-PEG) in malnourished patients with head and neck cancer.1 The current study aims to evaluate the safety and efficacy of trans-nasal PEG in patients with benign condition. Methods In this prospective study twelve consecutive patients who were referred for PEG insertion for benign conditions were allocated for conventional and t-PEG into 1:1 ratio over the study period of five months. All the cases were discussed in PEG multidisciplinary team meeting and procedures were performed by a single experienced endoscopist. Data were collected for sedation and comfort score and complications. A visual analogue scale was used for objective assessment of comfort. 14 French CORFLO gastrostomy tubes were used in all the cases. Results Seven of them were male and the mean age was 64.2 year (range: 21-81 year). The median follow up period was 27 weeks.More patients needed sedation and analgesia in conventional PEG group and mean sedation dose and comfort score were lower in t-PEG group. Nutritional goals were achieved in all the cases. There was no immediate complication in both group but, one patient in each group had their PEG tube dislodged after four weeks of insertion. Conclusion The findings from this study reaffirm that t-PEG placement using a small calibre endoscope through nasal route is safe, well tolerated and effective to maintain nutrition in patients with benign conditions. A multicenter randomised controlled trial is necessary to validate our findings and to evaluate the cost effectiveness.

Brucellosis is a disease which has rarely been seen in the UK since the pasteurization of milk. It often presents as a pyrexia of unknown origin and should be considered in the differential diagnosis. A case report is presented where the diagnosis was initially thought to be tuberculosis but months later was found to be brucellosis. The article then presents a summary of brucellosis and its management.