'Cut and push’ as an alternative to endoscopic retrieval of PEG type gastrostomy tubes
'Cut and push’ as an alternative to endoscopic retrieval of PEG type gastrostomy tubes
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.
Button gastrostomy, Cut and Push, PEG, Paediatric surgery, Percutaneous endoscopically placed gastrostomy, Upper gastrointestinal
Claxton, Harry
051b65b2-9310-4e68-b7e2-8a88a196cc81
Dick, Karen
a6a4901c-ee32-40a5-b428-5ea3fbe4f645
Taylor, Rhoda
44080072-5d46-4819-b46b-c383c5461d60
Allam, Maddie
98ab77d9-d7e6-40d3-97bc-d18077f72c91
Stedman, Francesca
ced0d372-3dbc-41fd-aa0b-80df1418f8e6
Keys, Charlie
24b01031-c4a2-451d-bcb9-38ee9f35d4b5
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
30 January 2023
Claxton, Harry
051b65b2-9310-4e68-b7e2-8a88a196cc81
Dick, Karen
a6a4901c-ee32-40a5-b428-5ea3fbe4f645
Taylor, Rhoda
44080072-5d46-4819-b46b-c383c5461d60
Allam, Maddie
98ab77d9-d7e6-40d3-97bc-d18077f72c91
Stedman, Francesca
ced0d372-3dbc-41fd-aa0b-80df1418f8e6
Keys, Charlie
24b01031-c4a2-451d-bcb9-38ee9f35d4b5
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Claxton, Harry, Dick, Karen, Taylor, Rhoda, Allam, Maddie, Stedman, Francesca, Keys, Charlie and Hall, Nigel
(2023)
'Cut and push’ as an alternative to endoscopic retrieval of PEG type gastrostomy tubes.
Pediatric Surgery International, 39 (1), [94].
(doi:10.1007/s00383-023-05382-5).
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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Cut and push paper Manuscript - PSI final
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Accepted/In Press date: 18 January 2023
e-pub ahead of print date: 30 January 2023
Published date: 30 January 2023
Additional Information:
Funding Information:
All authors declare that they do not have any financial and/or personal relationships with other people or organizations that could inappropriately influence (bias) their work to disclose. No financial support has been given/sort for the completion of this study.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Keywords:
Button gastrostomy, Cut and Push, PEG, Paediatric surgery, Percutaneous endoscopically placed gastrostomy, Upper gastrointestinal
Identifiers
Local EPrints ID: 474725
URI: http://eprints.soton.ac.uk/id/eprint/474725
ISSN: 0179-0358
PURE UUID: 2bca8b71-8948-490d-a37e-1aa40c0fea05
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Date deposited: 02 Mar 2023 17:34
Last modified: 17 Mar 2024 07:39
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Contributors
Author:
Harry Claxton
Author:
Karen Dick
Author:
Rhoda Taylor
Author:
Maddie Allam
Author:
Francesca Stedman
Author:
Charlie Keys
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