ANALYSIS OF BURIED BUMPER SYNDROME AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY DUE TO USE OF A BUTTON-TYPE KIT

A simple method for percutaneous endoscopic gastrostomy tube removal: "tie and retrograde pull"

BACKGROUND/PURPOSE

Various techniques have been presented to remove the percutaneous endoscopically placed gastrostomy tube in children, but tubes with semi-rigid internal retaining discs are difficult or impossible to remove by external traction. We describe a simple and effective endoscopic removal technique that should be applicable to any type of percutaneous endoscopic gastrostomy tube.

METHODS

Percutaneous endoscopic gastrostomy tube removal was performed with the "tie and retrograde pull" technique. After a polypropylene suture was placed and tied 1cm over the skin level, the percutaneous endoscopic gastrostomy tube was cut 0.5 cm over the knot. The suture was cut from the connection point between the needle and the suture. The distal end of the suture was pushed through the stoma into the stomach. Then a forceps was inserted through the gastroscope. The suture was caught, and the residual percutaneous endoscopic gastrostomy portion was retrieved via retrograde traction on the suture.

RESULTS

The causes of exchange were determined to be planned tube replacement in 9, buried bumper syndrome in 1, and tube occlusion in 3 patients. The mean tube dwell time was 10.8 ± 3.9 months. Esophageal mucosal tear developed in 1 patient with epidermolysis bullosa during removal. No other complications occurred during PEG tube exchanges.

CONCLUSION

This is a rapid and useful technique that does not require any complex endoscopic devices.

The Prevention and Management of Complications associated with established Percutaneous Gastrostomy Tubes in Adults: A Systematic Review

OBJECTIVE

This systematic review aimed to summarise the best available evidence relating to the prevention and management of complications associated with established percutaneous gastrostomy tubes in adults.

INCLUSION CRITERIA

This review considered studies investigating the effectiveness of strategies to prevent and/or manage complications associated with established percutaneous gastrostomy (PEG) tubes in adults where care was provided in the hospital, aged care or community setting. Complications included PEG stoma site infection, occlusion, site excoriation and inadvertent removal.

SEARCH STRATEGY

The search strategy aimed to find published and unpublished studies and was limited to reports published in the English language. Reference lists of studies that met the inclusion criteria were searched for additional studies. Company representatives were also contacted for information about ongoing or unpublished studies.

METHODOLOGICAL QUALITY

Study reports selected for retrieval were assessed by two independent reviewers for methodological quality prior to inclusion in the review using a critical appraisal instrument developed specifically for this review.

RESULTS

There were 40 studies that met the inclusion criteria for this review. Thirty-five were excluded after critical appraisal. The five remaining studies contained information regarding strategies for the prevention and/or management of site infection, occlusion and inadvertent removal. There were no studies include that addressed excoriation at the stoma site. Reported strategies for the prevention of complications included regular follow-up, the provision of pre discharge instructions and programmed tube changes. Strategies reported for the management of site infection included local antibiotic therapy, skin care and intravenous antibiotic therapy. Reported interventions for the management of occlusion included the use of enzymes, guidewires, flushing, replacement and removal. The only intervention reported for the management of inadvertent removal was replacement.

CONCLUSION

The research regarding the prevention and management of complications associated with PEG tubes is sparse and potentially of poor quality. Interventions are often poorly described and few comparative studies are published. While few recommendations for practice can be made a range of recommendations for future research are provided. There is an urgent need for further research examining many aspects of the prevention and management of complications associated with PEG tubes.