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The "cut and push" method of removing percutaneous endoscopic gastrostomy tube is not safe in paediatric patients
Nasib Alchoikani1, Collette Donnelly2, Suzanne Lawther2
1University Hospital Southampton NHS Foundation Trust, Southampton, UK. nasib.alchoikani@doctors.org.uk.
Insights
The "cut and push" (CP) method for removing percutaneous endoscopic gastrostomy (PEG) tubes is not safe for children. This study found a high rate of retained internal components and severe complications, suggesting the method should be abandoned.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
Background:
- The
Purpose of the Study:
- To investigate the safety of the
Main Methods:
- Retrospective review of 27 pediatric patients undergoing CP removal/replacement of Freka PEG tubes (Jan 2016 - Aug 2021).
- Post-procedure follow-up included stool monitoring, plain film radiography, and CT scans to assess for retained internal components.
- Complications were evaluated, including the need for surgical or endoscopic intervention.
Main Results:
- Six patients (22.2%) passed the internal component in stool.
- Five patients (18.5%) had retained internal components.
- Three patients (11.1%) experienced major complications requiring complex surgical intervention; two (7.4%) required endoscopic retrieval.
Conclusions:
- The CP method for PEG tube removal in children is associated with a higher incidence of severe complications than previously reported.
- This technique is deemed unsafe for pediatric use and should be discontinued.
- Children with Down syndrome may face an elevated risk of component retention and subsequent complications.
Purpose:
A "cut and push" (CP) approach has been described in the literature for removal of percutaneous endoscopic gastrostomy (PEG) tubes. The aim of this study is to investigate the safety profile of this method in children.
Method:
Our study included all children who underwent CP procedure for either removal or replacement of Freka PEG tube at our centre between January 2016 and August 2021. Parents contacted to establish if the internal component had been seen in the stools post-procedure. If not seen, a plain film of chest, abdomen and pelvis was arranged followed by computerised tomography (CT) scan. The presence of the internal component as a retained foreign body on imaging was evaluated along with any complication.
Results:
Of the 27 patients included, six (22.2%) patients had the internal component seen in the stool. Five (18.5%) patients in total had a retained internal component with three (11.1%) patients had major complications requiring complex surgical interventions, and two (7.4%) patients required endoscopic retrieval.
Conclusion:
Our study reports more severe complications that required complex surgical interventions compared to the previous studies. We believe that this method of removal is not safe in children and should be abandoned. Also, patients with Down syndrome might be at higher risk of retention and complications.
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