Feasibility of the Cut‐and‐Push Method for Removing Large‐Caliber Soft Percutaneous Endoscopic Gastrostomy Devices

Abstract

The cut-and-push method employed for removal of a soft PEG tube with a large caliber seems to be safe and can be performed when removal by external traction may determine the occurrence of peristomal complications or jeopardize PEG replacement.

Percutaneous Endoscopic Gastrostomy Tube Replacement Unexpected Serious Events

“…Use of balloon‐tipped PEG tubes could minimize the potential danger of disruption of the gastrocutaneous canal. Endoscopic removal or cutting the indwelling tube and allowing disposal of the internal bumper via the gastrointestinal tract (the cut‐and‐push method 7 ) are acceptable. However, the cost‐effectiveness of endoscopy in this setting is questionable and the second alternative possesses a minimal risk of bowel obstruction, although this risk has not been detected in the largest so far, prospective study of using the cut‐and‐push method to replace PEG devices larger than 15 Fr 7 .…”

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

“…Five cohort studies were identified that reported the use of CP in larger groups of patients (4)(5)(6)(7)(8). Of these three studies were prospective ( 4,5,8 ) and two were retrospective ( 6, 7 ).…”

“…X-ray is considered to provide unequivocal evidence of flange excretion ( 4 ) but this was only reported in 68 cases ( 4,5 ). Most frequently excretion of the flange was confirmed by visualization of the flange in the stool and was reported in 98 cases, usually by the patient or caregiver ( 4,5,8 ). Two studies reported a combination of x-ray verification and flange seen in stool ( 4, 5 ) whilst Agha ( 8 ) reported flange seen in stool.…”

“…All studies except for Korula and Harma ( 4 ) state exclusion criteria when assessing patients for suitability of CP. These include: children, pyloric stenosis, intestinal strictures, motility disorders, cystic fibrosis, immobility, constipation and a history of abdominal surgery ( [5][6][7][8] ).…”

“…Similarly, Pearce et al ( 7 ) studied 73 adult patients, identifying complications in two patients. Most recently Agha et al ( 8 ) removed 79 large calibre PEG tubes, using the CP method ,reporting PEG remnant seen in patients stool in 63 cases with zero complications in all patients over a one month follow up period. Three of the four cohort studies published have been from the UK ( [5][6][7], which may be reflective of the healthcare system.…”