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Nonendoscopic removal of percutaneous endoscopic gastrostomy tubes: morbidity and mortality in children
M Yaseen1, M I Steele, J E Grunow
1Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA.
Insights
Allowing percutaneous endoscopic gastrostomy (PEG) tube internal components to pass through the GI tract is risky for children. Younger, smaller patients face higher complication risks, necessitating vigilant monitoring and imaging if passage is unconfirmed.
Area of Science:
- Pediatric Gastroenterology
- Medical Device Safety
- Endoscopic Procedures
Background:
- Percutaneous endoscopic gastrostomy (PEG) tubes are common in pediatric care.
- Standard removal involves cutting the tube at skin level, allowing internal components to pass naturally.
- Safety data for this removal method in children is limited.
Purpose of the Study:
- To evaluate the safety of non-endoscopic PEG tube removal in pediatric patients.
- To identify potential complications associated with allowing internal PEG components to pass spontaneously.
- To compare risks in pediatric patients versus adults.
Main Methods:
- Retrospective review of pediatric patients undergoing PEG tube removal.
- Analysis of clinical courses over a 3-year period in a pediatric gastroenterology unit.
- Assessment of complications related to retained internal PEG components.
Main Results:
- Five of 11 pediatric patients experienced significant complications after PEG tube removal.
- Complications included persistent vomiting requiring endoscopic intervention, esophageal perforation with mortality, and gastrocutaneous fistula.
- Younger and smaller children exhibited a higher incidence of severe complications.
Conclusions:
- The non-endoscopic removal of PEG tube internal components poses substantial risks to pediatric patients.
- Children, particularly those younger and smaller, are at increased risk compared to adults.
- Radiographic monitoring (chest and abdominal X-rays) is recommended if internal component passage is not confirmed within two weeks.
Background:
Percutaneous endoscopic gastrostomy (PEG) tubes are often removed by cutting the tubing at skin level and allowing the internal components to pass through the gastrointestinal tract. This technique is commonly used in adults, but little information is available concerning its safety in younger patients.
Methods:
To assess the safety of this approach in children, the clinical courses of all patients who had undergone PEG tube removal in our pediatric gastroenterology unit over a 3-year period were reviewed.
Results:
Five of 11 patients in whom the internal components were allowed to pass developed significant complications. Three required subsequent endoscopic removal of the internal component due to persistent vomiting, one died from complications of esophageal perforation caused by the retained internal component, and one developed a gastrocutaneous fistula containing the retained bumper 2 years after PEG tube removal. Significant complications occurred more often in the younger and smaller patients.
Conclusions:
Small children are at greater risk than adults for developing serious complications associated with unremoved PEG tube internal components. If passage of the internal components cannot be confirmed after 2 weeks, chest and abdominal radiographs should be obtained.
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