During percutaneous endoscopic gastrostomy (PEG) with a conventional transoral gastroscope, the insertion of the gastroscope can cause a great deal of discomfort to the patient. At the same time, in patients with difficulty in opening the mouth or narrowing of the pharynx, regular gastroscopy-assisted gastrostomy often fails because the endoscope cannot pass through. The application of ultra-fine nasogastroscopy in PEG can overcome these shortcomings. In this paper, we will introduce the transnasal PEG method (Transnasal PEG, nPEG). The Introducer method was used to compare the time, safety, and complications and comfort of the two methods of operation in nine consecutive patients hospitalized with gastrostomy requiring percutaneous endoscopic gastrostomy with regular gastroscopy and ultra-fine nasogastroscopy, respectively. To observe the use of ultra-fine nasogastroscopy in patients with difficult mouth opening or pharyngeal strictures. Of the 9 patients in this group, 5 had gastrostomy with plain gastroscopy and 4 had gastrostomy with ultra-fine nasogastroscopy, both of which were successful. 3 of the 4 patients with nPEG were post-radiotherapy patients with nasopharyngeal cancer, 2 of whom had difficulty opening their mouth and 1 had difficulty opening their mouth with pharyngeal stenosis. The average time of plain endoscopic gastrostomy was 17±3.5 min, while that of the nPEG group was 17±3.1 min. there were no complications in both methods, but the comfort of patients in the nPEG group was better. Conclusion: Ultra-fine nasogastrostomy-assisted gastrostomy is a more comfortable and safe gastrostomy method, especially for patients with various causes of difficult mouth opening and/or pharyngeal strictures. Gastrointestinal nutrition is an effective means of long-term nutritional support therapy. Although transgastric or gastrojejunal tube nutrition support can be used for nutritional support therapy for a short period of time, long-term nutrition can cause esophageal mucosal ulceration due to the compression of the esophageal mucosa by the nutrition tube; in some patients, the insertion of the nutrition tube can cause serious misaspiration, so percutaneous endoscopic gastrostomy (Percutaneous endoscopic gastrostomy, PEG) or gastrostomy/jejunostomy is the modality of choice for long-term gastrointestinal nutrition in most patients. However, conventional PEG can be limited in some cases, such as strictures in the upper esophagus or pharynx, or difficulty opening the mouth for various reasons. In addition, the PEG procedure is also longer, and performing PEG under non-analgesic/sedative conditions can cause significant pain to the patient. The use of ultra-fine nasogastroscopy instead of conventional gastroscopy for gastrostomy (Transnasal PEG, nPEG) can remedy some of these deficiencies. In this paper, the nPEG method is described and compared with conventional gastroscopy-assisted PEG, and the results are reported below. 1. Patients and methods 1.1 Patients Patients were from 9 patients, 5 males and 4 females, aged 56-73 years old, who underwent gastrostomy at the First Affiliated Hospital of Guangzhou Medical College from 2008.7 to 2008.10. They needed PEG for gastrointestinal nutrition tube placement with severe reflux esophagitis, esophageal cancer, nasopharyngeal cancer (after radiotherapy) or dementia, respectively. all patients or their guardians signed an informed consent form. 1.2 Methods 1.2.1 Percutaneous endoscopic gastrostomy method: When performing gastrostomy, for patients with upper esophageal stenosis there are methods described in the literature to dilate the probe until it can pass through the gastroscope. The gastroscope used for the fistula was an Olympus GIF-XQ260 (i.e., transoral conventional gastroscope) or GIF-N260 (i.e., supercellular nasogastroscope, inserted through the nasal cavity). Before performing nPEG, the nasal turbinates were constricted with 2% ephedrine, followed by nasal mucosal surface anesthesia with 1% bupivacaine, and pharyngeal mucosal surface anesthesia as for conventional endoscopy. No analgesia/sedation was used in all cases, and the Introducer [2] gastrostomy method was performed using references to the literature and product instructions. 1.2.1 Introducer PEG method. The product of Create Medical Co. Ltd. of Japan (distributed by Xi’an Junkun Company) was used. The patient was placed flat on the gastroscopy bed with the upper body and head elevated at 15°, and the blood pressure, pulse and oxygen saturation were monitored and the airway was kept open. After the gastric cavity is fully inflated by gas injection, the room light is turned off to observe the transillumination of the abdominal wall, and the pressure on the abdominal wall is observed by finger pressure to determine the proposed fistula site. In cases where the patient’s nutritional status is good and the abdominal wall is not translucent, the fistula site can be determined based on the abdominal wall pressure alone. Prior to fistula, routine disinfection, towel laying, and local total abdominal wall anesthesia with 1% lidocaine are performed, and further vertical needle penetration of the abdominal wall is performed to observe the presence of intra-needle air bubbles. Before the abdominal wall-gastric wall puncture with the puncture needle, the gastric wall and abdominal wall were fixed with a perch-type gastric wall fixator at approximately 1.0-2.0 cm above and below the gastrostomy site with 0 or 2 surgical sutures. Afterwards, the puncture was performed with a sheathed puncture needle, and when the sheath reached the gastric cavity, the puncture needle was withdrawn and a 15F gastrostomy tube was inserted from inside the sheath. After filling the gastrostomy tube balloon with 3.0 ml of water for injection, the outer sheath was removed and peeled off, and the gastrostomy tube balloon was tightly contacted with the gastric wall under endoscopic surveillance before local sterilization of the abdominal wall and fixation of the gastrostomy tube. Antibiotics were administered before and after the gastrostomy to prevent infection, and feeding was performed 24 h after the fistula, and the sutures fixing the gastric wall were removed 1 week after the operation.