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

Pratt, Janey; Green, Sue

doi:10.1016/j.clnesp.2017.05.004

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…This is particularly useful for patients with a D-PEJ, in whom endoscopic retrieval can be particularly challenging and invasive [36]. Endoscopic retrieval of the bumper is recommended in cases with previous bowel surgery and for patients at risk of strictures or ileus, which could hinder spontaneous migration and elimination of the tube remnant and bumper [1,157,158].…”

Section: Definitive Enteral Tube Removalmentioning

confidence: 99%

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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Main recommendationsESGE recommends the “pull” technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer (“push”) technique for PEG placement in cases where the “pull” method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed “blindly” at the patient’s bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 – 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 – 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.

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Section: Definitive Enteral Tube Removalmentioning

confidence: 99%

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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“…This suggests complications following C&P are uncommon. In a systematic review including 5 cohort studies and 22 case studies with a total of 373 cases of C&P, a complication rate of less than 1% was identified [ 1 ]. The most frequent complication was gastrointestinal obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent complication was gastrointestinal obstruction. While often resolving spontaneously, these complications sometimes require intervention such as laparotomy or endoscopy [ 1 ]. A small number of case studies report significant complications following C&P in adults including peritonitis, bleeding and even mortality [ 9 – 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…When gastrointestinal obstruction does occur, it has been reported in various sites, from the oesophagus and stomach through the intestine and at ileostomy sites. Time until obstruction ranged up to almost 2 years following C&P in adults, most frequently occurring at around 9 weeks post procedure [ 1 ]. Overall, in the adult literature, the majority of complications are seen in patients who have either undergone previous abdominal surgery or who have comorbidities increasing the risk of decreased intestinal motility or intestinal stricture [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous Endoscopically placed Gastrostomy (PEG) tubes are frequently used in children for a variety of reasons including nutritional supplementation, exclusive route of nutrition and medication administration. Within the stomach the PEG is held in place with a ‘flange’, a flexible disk held against the internal stomach wall [ 1 ]. Most PEG tubes require either removal or replacement as a matter of course [ 2 ] either due to tube deterioration or patient choice and traditionally this is achieved by accessing the flange via endoscopy.…”

Section: Introductionmentioning

confidence: 99%

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‘Cut and push’ as an alternative to endoscopic retrieval of PEG type gastrostomy tubes

et al. 2023

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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. Supplementary Information The online version contains supplementary material available at 10.1007/s00383-023-05382-5.

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Enteral Nutrition

Bowling

2023

Intestinal Failure

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

Abstract: 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.

Cited by 5 publications

References 30 publications

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

‘Cut and push’ as an alternative to endoscopic retrieval of PEG type gastrostomy tubes

Enteral Nutrition

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