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. 2023 Jan 30;39(1):94.
doi: 10.1007/s00383-023-05382-5.

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

Harry Claxton  1 , Karen Dick  2 , Rhoda Taylor  2 , Maddie Allam  2 , Francesca Stedman  2 , Charlie Keys  2 , Nigel J Hall  2   3
Affiliations

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

Harry Claxton et al. Pediatr Surg Int. .

Abstract

Purpose: Percutaneous Endoscopically placed Gastrostomy (PEG) tubes are frequently used in children. The traditional endoscopic method to remove/change the PEG device requires general anaesthesia in children. A minimally invasive alternative is the 'Cut and Push' method (C&P): avoiding the risks/wait times of general anaesthesia and reducing resource burden. Data regarding the safety/effectiveness of C&P in children are lacking with concerns raised about the possibility of gastrointestinal obstruction.

Methods: We retrospectively reviewed all cases of PEG removal / change to button in children (< 18 years) between December 2020 and January 2022. Cases were identified from a prospectively maintained database and all cases of C&P included. Parents/carers were asked if the child had suffered any complications following C&P and if flange was visualised in stools.

Results: During the time period, 27 PEGs were either removed or changed to button via C&P. The average waiting time for C&P was 14.29 days, significantly shorter than the minimum 6-month waiting time for elective endoscopy. Our evaluation revealed no complications of C&P at median 70 days (range 25-301). In three cases the flange was visualised in the stool, at 2 days, 3 days and 5 weeks following C&P respectively.

Discussion: These data support the available literature suggesting C&P is an effective means to facilitate minimally invasive and prompt PEG removal/change to button in children. We recommend minimum weight and age parameters for this procedure and further evaluation of the safety and resource implications of this technique.

Keywords: Button gastrostomy; Cut and Push; PEG; Paediatric surgery; Percutaneous endoscopically placed gastrostomy; Upper gastrointestinal.

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Conflict of interest statement

The authors declare no competing interests.

All authors declare that they do not have any conflicts of interest.

Figures

Fig. 1
Fig. 1
Demonstrates the information sheet that parents / carers are provided with either when considering or following the C&P procedure. The document both explains the risks and benefits of the procedure
See this image and copyright information in PMC

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