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Claxton H, Dick K, Taylor R, Allam M, Stedman F, Keys C, Hall NJ. ‘Cut and push’ as an alternative to endoscopic retrieval of PEG type gastrostomy tubes. Pediatr Surg Int 2023; 39:94. [PMID: 36715765 PMCID: PMC9885393 DOI: 10.1007/s00383-023-05382-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/31/2023]
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.
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Affiliation(s)
- Harry Claxton
- Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, 18 Woodham Park Road, Woodham, Addlestone, Surrey, Southampton, KT153ST UK
| | - Karen Dick
- Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, 18 Woodham Park Road, Woodham, Addlestone, Surrey, Southampton, KT153ST UK
| | - Rhoda Taylor
- Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, 18 Woodham Park Road, Woodham, Addlestone, Surrey, Southampton, KT153ST UK
| | - Maddie Allam
- Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, 18 Woodham Park Road, Woodham, Addlestone, Surrey, Southampton, KT153ST UK
| | - Francesca Stedman
- Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, 18 Woodham Park Road, Woodham, Addlestone, Surrey, Southampton, KT153ST UK
| | - Charlie Keys
- Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, 18 Woodham Park Road, Woodham, Addlestone, Surrey, Southampton, KT153ST UK
| | - Nigel J. Hall
- Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, 18 Woodham Park Road, Woodham, Addlestone, Surrey, Southampton, KT153ST UK ,University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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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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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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Subotic U, Holland-Cunz S, Wirth H, Wessel L. Ileus nach nicht endoskopischer PEG-Entfernung. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-006-1367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Percutaneous endoscopic gastrostomy (PEG) is a procedure commonly performed in children who require long-term enteral nutritional support. Although simple, PEG insertion carries the risk of severe and potentially life-threatening complications. Attention to detail is paramount in preventing such complications. Removal is also associated with complications. We describe a simple and inexpensive technique, just requiring a loop nylon suture, which is a useful adjunct to standard endoscopic removal or change of PEG. This modified technique is particularly useful in the untoward event of gastric separation from the anterior abdominal wall during gastrostomy tract dilatation or insertion of the new button device.
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Affiliation(s)
- Marco Castagnetti
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, SE5 9RS London, UK
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Abstract
Improvements in the provision of oxygen, mechanical ventilation, tracheostomy care, enteral and parenteral nutrition, and dialysis have expanded the population of technology-dependent children. This article attempts to review pertinent points regarding these services, including common complications. Primary care and subspecialty physicians must smooth the transition of these children to the home environment, but a comprehensive team approach is necessary for the recognition of medical complications and provision of appropriate family teaching and psychosocial supports.
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Affiliation(s)
- J C Haffner
- Division of Critical Care Medicine, University of South Florida College of Medicine and All Children's Hospital, St. Petersburg, Florida, USA
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Kobak GE, McClenathan DT, Schurman SJ. Complications of removing percutaneous endoscopic gastrostomy tubes in children. J Pediatr Gastroenterol Nutr 2000; 30:404-7. [PMID: 10776951 DOI: 10.1097/00005176-200004000-00010] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Little information has been reported regarding the frequency and type of complications arising from removal of percutaneous endoscopic gastrostomy (PEG) tubes in children. METHODS The records of 397 patients who had PEG tubes placed from 1993 through 1998 were reviewed for complications after removal. Data collected included length of time the tube was in place, age of the patient at insertion, type of tube removed, and patient diagnosis. RESULTS Fifty-four children had the PEG tube removed by traction or endoscopy. The only complication was persistent leaking through a gastrocutaneous fistula in 13 patients (24%). Leaking ceased in 6 children coincident with H2-antagonist therapy and silver nitrate cautery, and surgical closure of the fistula was required in 7 patients. Comparison of these 7 children with those who did not require surgery (n = 47) showed a longer duration of tube placement (mean +/- SE of 20.6+/-3.6 months, range 11-31 months vs. 11.1+/-1.3 months, range 1-35 months; P<0.05). Further analysis showed no child with a PEG tube removed before 11 months (n = 23) after insertion required surgery, whereas 7 (23%) of 31 children with a PEG tube removed after 11 or more months required surgery. Age at insertion, type of feeding device removed, and patient diagnoses were not different between the two groups. CONCLUSIONS These data indicate that persistent leaking necessitating surgical closure of a gastrocutaneous fistula does not occur in children with a PEG tube removed within 11 months of insertion. In contrast, 23% of children with a PEG tube removed 11 or more months after insertion require surgery. In patients identified as candidates for tube removal, this time frame may be important in clinical decision making.
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Affiliation(s)
- G E Kobak
- Department of Pediatrics, University of South Florida College of Medicine and All Children's Hospital, St. Petersburg, USA
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