'Cut and push' as an alternative to endoscopic retrieval of PEG type gastrostomy tubes

Area of Science:

• Pediatric Gastroenterology
• Minimally Invasive Procedures
• Medical Device Management

Background:

• Percutaneous Endoscopically placed Gastrostomy (PEG) tubes are common in pediatric care.
• Traditional PEG removal/replacement often requires general anesthesia, posing risks and increasing healthcare burdens.
• The 'Cut and Push' (C&P) method is a less invasive alternative, but its safety and efficacy in children require further investigation.

Purpose of the Study:

• To evaluate the safety and effectiveness of the 'Cut and Push' (C&P) method for Percutaneous Endoscopically placed Gastrostomy (PEG) tube removal or replacement in pediatric patients.
• To assess potential complications, such as gastrointestinal obstruction, associated with the C&P technique in children.

Main Methods:

• A retrospective review of pediatric cases (under 18 years) involving PEG removal or conversion to a button using the C&P method between December 2020 and January 2022.
• Data were collected from a prospectively maintained database.
• Parents/caregivers were surveyed regarding post-procedure complications and the visualization of the PEG flange in stools.

Main Results:

• Twenty-seven PEG removal/replacement procedures were performed using the C&P method.
• The average waiting time for C&P was 14.29 days, significantly shorter than the typical 6-month wait for elective endoscopy.
• No complications were reported at a median follow-up of 70 days; the PEG flange was visualized in stools in three cases at varying intervals.

Conclusions:

• The 'Cut and Push' (C&P) method is a safe and effective minimally invasive technique for pediatric PEG tube management.
• C&P facilitates prompt PEG removal/replacement, reducing the need for general anesthesia and associated wait times.
• Further research is recommended to establish age and weight parameters and fully assess the safety and resource implications of C&P in children.