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Removal of percutaneous endoscopic gastrostomy tubes in adults using the “cut and push” method: A systematic review

Removal of percutaneous endoscopic gastrostomy tubes in adults using the “cut and push” method: A systematic review
Removal of percutaneous endoscopic gastrostomy tubes in adults using the “cut and push” method: A systematic review

Background:

PEG tubes are inserted for long term enteral feeding and may need to be removed at some point post insertion. A recognized method to remove the PEG is the cut and push method (CP). Some studies have suggested that CP is safe whilst others have reported complications and death. Subsequently the use of CP is not uniform but, if safe, could provide a cost effective, minimally invasive, alternative to gastroscopy. The aim of this study was to locate and critically appraise all publications relevant to CP in adult patients using a systematic approach.


Method:

Systematic searching of electronic databases Embase, Medline and Cinahl, using keywords in title and abstracts. Exclusions were: non-human, under 18 years of age, English language. Time limits were not applied. Preliminary searching gave 538 hits that were then hand reviewed for relevance. Selected studies were critically appraised and data summarized into tables for use in the review.


Results:

27 records were included in the review spanning from 1990–2014. A total of 21 case reports detailing complications in 24 individuals, including 5 deaths. There were 5 cohort studies and 1 case report detailing the safe use of CP, with 3 complications. Cases totalled 373 with 27 complications (7%). Most common complication was gastrointestinal obstruction, usually occurring in the first 6 months post CP. A history of bowel surgery was evident in some cases where obstruction occurred. The majority of cohort studies reported the use of assessment criteria to exclude those at risk of obstruction and reported low complication rates.


Conclusions:

The quality and quantity of the evidence on CP is insufficient to make recommendations for clinical practice. Further research is needed to evaluate the effectiveness of CP.
0261-5614
59-65
Pratt, J.
3749941e-51a7-44a6-ad54-96351bf44171
Green, S.
1075a760-2a75-443c-96c7-194d0d90ede8
Pratt, J.
3749941e-51a7-44a6-ad54-96351bf44171
Green, S.
1075a760-2a75-443c-96c7-194d0d90ede8

Pratt, J. and Green, S. (2017) Removal of percutaneous endoscopic gastrostomy tubes in adults using the “cut and push” method: A systematic review. Clinical Nutrition, 21, 59-65. (doi:10.1016/j.clnesp.2017.05.004).

Record type: Article

Abstract


Background:

PEG tubes are inserted for long term enteral feeding and may need to be removed at some point post insertion. A recognized method to remove the PEG is the cut and push method (CP). Some studies have suggested that CP is safe whilst others have reported complications and death. Subsequently the use of CP is not uniform but, if safe, could provide a cost effective, minimally invasive, alternative to gastroscopy. The aim of this study was to locate and critically appraise all publications relevant to CP in adult patients using a systematic approach.


Method:

Systematic searching of electronic databases Embase, Medline and Cinahl, using keywords in title and abstracts. Exclusions were: non-human, under 18 years of age, English language. Time limits were not applied. Preliminary searching gave 538 hits that were then hand reviewed for relevance. Selected studies were critically appraised and data summarized into tables for use in the review.


Results:

27 records were included in the review spanning from 1990–2014. A total of 21 case reports detailing complications in 24 individuals, including 5 deaths. There were 5 cohort studies and 1 case report detailing the safe use of CP, with 3 complications. Cases totalled 373 with 27 complications (7%). Most common complication was gastrointestinal obstruction, usually occurring in the first 6 months post CP. A history of bowel surgery was evident in some cases where obstruction occurred. The majority of cohort studies reported the use of assessment criteria to exclude those at risk of obstruction and reported low complication rates.


Conclusions:

The quality and quantity of the evidence on CP is insufficient to make recommendations for clinical practice. Further research is needed to evaluate the effectiveness of CP.

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More information

Accepted/In Press date: 22 May 2017
e-pub ahead of print date: 26 June 2017
Published date: October 2017

Identifiers

Local EPrints ID: 412840
URI: https://eprints.soton.ac.uk/id/eprint/412840
ISSN: 0261-5614
PURE UUID: bb837d53-79bf-4071-aa1c-e2bf9ef8f298
ORCID for S. Green: ORCID iD orcid.org/0000-0003-1760-3679

Catalogue record

Date deposited: 02 Aug 2017 16:30
Last modified: 20 Jul 2019 05:02

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