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Alchoikani N, Donnelly C, Lawther S. The "cut and push" method of removing percutaneous endoscopic gastrostomy tube is not safe in paediatric patients. Pediatr Surg Int 2023; 40:4. [PMID: 37993741 DOI: 10.1007/s00383-023-05575-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/24/2023]
Abstract
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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Affiliation(s)
- Nasib Alchoikani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Rapid repair of percutaneous endoscopic gastrostomy tubes using three-dimensional printing: A case series. ANNALS OF 3D PRINTED MEDICINE 2023. [DOI: 10.1016/j.stlm.2022.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Melling G, Farley J. Complication rates associated with traction removal of percutaneous endoscopic gastrostomy tubes. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S22-S26. [PMID: 35404661 DOI: 10.12968/bjon.2022.31.7.s22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes are removed and/or replaced for reasons such as tube malfunction, degradation, patient's device preference, and when stopping enteral feeding. AIMS To identify the types and rate of complications associated with traction removal of a PEG tube and if this is associated with the size of the PEG or length of time it had been in situ prior to removal. METHODS This retrospective study looked at the tube removal/replacement reports written by the Enteral Feeding Nursing Service over an 8-year period at a large teaching hospital trust in the north of England. FINDINGS The PEG tube removal reports of 127 patients were reviewed. Five types of complication were identified, categorised as retained bumper (5.5%); intraperitoneal placement of new device (3.17%); misplacement of replacement device into colon (a consequence of the insertion procedure not the removal of the PEG) (0.78%): gastrocutaneous fistula (0.78%); and inability to remove the tube (1.57%). The complication of retained bumpers was associated with an average length of time in situ prior to removal of the PEG tube of 29 months. In the cases of intraperitoneal placement, the PEG tube had been in situ for an average of 6 months. Nurses were unable to remove the PEG tube on two occasions; each had been in situ for approximately 4 years prior to attempted removal. CONCLUSION the complication rates are low following removal of a PEG tube using a traction pull. There was no clear correlation between length of time in situ or tube size and complication rate.
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Affiliation(s)
- Georgina Melling
- Clinical Nurse Specialist Enteral Feeding, Leeds Teaching Hospitals NHS Trust
| | - Joshua Farley
- Clinical Nurse Specialist Enteral Feeding, Leeds Teaching Hospitals NHS Trust
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Thomas H, Yole J, Livingston MH, Bailey K, Cameron BH, VanHouwelingen L. Replacing gastrostomy tubes with collapsible bumpers in pediatric patients: Is it safe to "cut" the tube and allow the bumper to pass enterally? J Pediatr Surg 2018. [PMID: 29526351 DOI: 10.1016/j.jpedsurg.2018.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The "cut and push" technique for removal of percutaneous endoscopic gastrostomy (PEG) tubes with collapsible bumpers offers an alternative to the standard traction method of removal. This study compared the outcomes of these techniques. METHODS We completed a research ethics board-approved retrospective cohort study, identifying all patients less than 18years of age who underwent PEG tube removal at a children's hospital between December 2013 and December 2016. Outcomes included need for sedation and complications. RESULTS We identified 127 children who had PEG tubes removed. Significantly fewer children required sedation with the cut and push group (1.1% vs. 60.6%, p≤0.001). Ten complications occurred, including 9 in the cut and push group (9.6% vs. 3%, p=0.23). Mean age at time of complication was significantly younger in the cut and push group (2.2 vs. 6.3years p=0.004). CONCLUSION This is the largest reported series comparing the cut and push vs. traction removal methods. The cut and push technique significantly reduced the need for procedural sedation but was associated with increased risk of complications. While these data suggest that the technique is safe in older children, caution should be taken in younger children who appear to be more likely to vomit the residual bumper. LEVELS OF EVIDENCE Level III-Treatment study, Retrospective comparative study.
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Affiliation(s)
- Heather Thomas
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Juravinski Hospital, Hamilton, Ontario, Canada
| | - Julia Yole
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Livingston
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Karen Bailey
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Brian H Cameron
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lisa VanHouwelingen
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada.
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Kvello M, Knatten CK, Perminow G, Skari H, Engebretsen A, Schistad O, Emblem R, Bjørnland K. Initial experience with percutaneous endoscopic gastrostomy with T-fastener fixation in pediatric patients. Endosc Int Open 2018; 6:E179-E185. [PMID: 29399615 PMCID: PMC5794435 DOI: 10.1055/s-0043-122227] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Insertion of a percutaneous endoscopic gastrostomy (PEG) with push-through technique and T-fastener fixation (PEG-T) has recently been introduced in pediatric patients. The T-fasteners allow a primary insertion of a balloon gastrostomy. Due to limited data on the results of this technique in children, we have investigated peri- and postoperative outcomes after implementation of PEG-T in our department. PATIENTS AND METHODS This retrospective chart review included all patients below 18 years who underwent PEG-T placement from 2010 to 2014. Main outcomes were 30-day postoperative complications and late gastrostomy-related complications. RESULTS In total, 87 patients were included, and median follow-up time was 2.4 years (1 month - 4.9 years). Median age and weight at PEG-T insertion were 1.9 years (9.4 months - 16.4 years) and 10.4 kg (5.4 - 33.0 kg), respectively. Median operation time was 28 minutes (10 - 65 minutes), and 6 surgeons and 3 endoscopists performed the procedures. During the first 30 days, 54 complications occurred in 41 patients (47 %). Most common were peristomal infections treated with either local antibiotics in 11 patients (13 %) or systemic antibiotics in 11 other patients (13 %). 9 patients (10 %) experienced tube dislodgment. Late gastrostomy-related complications occurred in 33 patients (38 %). The T-fasteners caused early and late complications in 9 (10 %) and 11 patients (13 %), respectively. Of these, 4 patients (5 %) had subcutaneously migrated T-fasteners which were removed under general anesthesia. CONCLUSION We found a high rate of complications after PEG-T. In particular, problems with the T-fasteners and tube dislodgment occurred frequently after PEG-T insertion.
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Affiliation(s)
- Morten Kvello
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway,Corresponding author Morten Kvello Department of Gastrointestinal and Pediatric SurgeryOslo University HospitalRikshospitaletPostboks 4950 Nydalen0424 OsloNorway+47-2-3072526
| | | | - Gøri Perminow
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Hans Skari
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Anders Engebretsen
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Ole Schistad
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Emblem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Kristin Bjørnland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
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ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr 2015; 60:131-41. [PMID: 25023584 DOI: 10.1097/mpg.0000000000000501] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position statement provides a comprehensive guide for health care providers to manage percutaneous endoscopic gastrostomy tubes in a safe, effective, and appropriate way. METHODS Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of evidence, recommendations reflect the expert opinion of the authors. Final consensus was obtained by multiple e-mail exchange and during 3 face-to-face meetings of the gastroenterology committee of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. RESULTS Endoscopically placed gastrostomy devices are essential in the management of children with feeding and nutritional problems. The article focuses on practical issues such as indications and contraindications. CONCLUSIONS The decision to place an endoscopic gastrostomy has to be made by an appropriate multidisciplinary team, which then provides active follow-up and care for the child and the device.
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Renji E, Nathan AK, Dalzell MA. Hidden treasure in an endoscopically retrieved oesophageal trichobezoar. BMJ Case Rep 2013; 2013:bcr-2012-007858. [PMID: 23334492 DOI: 10.1136/bcr-2012-007858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 12-year-old girl with Smith-Lemli-Opitz syndrome and gastrostomy dependency presented with multiple episodes of coffee ground vomits. An upper gastrointestinal endoscopy revealed a trichobezoar in the lower oesophagus, with a 'hidden treasure'-a retained end of a G tube at the core. Endoscopic retrieval led to resolution of symptoms. Literature is scant with only one previous report of an oesophageal trichobezoar. Techniques of removal of percutaneous endoscopic gastrostomy in children are reviewed. The pathogenesis, preventative measures and management for oesophageal trichobezoars are discussed.
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Affiliation(s)
- Elizabeth Renji
- Department of Paediatric Gastroenterology, Alderhey Childrens Hospital, Liverpool, UK.
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Park JH, Rhie S, Jeong SJ. Percutaneous endoscopic gastrostomy in children. KOREAN JOURNAL OF PEDIATRICS 2011; 54:17-21. [PMID: 21359056 PMCID: PMC3040361 DOI: 10.3345/kjp.2011.54.1.17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 10/14/2010] [Accepted: 11/09/2010] [Indexed: 01/22/2023]
Abstract
Purpose Percutaneous endoscopic gastrostomy (PEG) can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG. Methods We retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6) months. Results Mean patient age was 9.4 (4.5) years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD). The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87%) had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment. Conclusion PEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.
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Affiliation(s)
- Jye Hae Park
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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