An Evaluation of the “Cut and Push” Method of Percutaneous Endoscopic Gastrostomy (PEG) Removal

Merrick, Susan; Harnden, Sarah; Shetty, Shishir; Chopra, Preeti; Clamp, Philip; Kapadia, S.

doi:10.1177/014860710803200178

Cited by 17 publications

(27 citation statements)

References 8 publications

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“…For non-traction removable devices, the choice is between endoscopic retrieval of the internal bumper or cutting the tube and allowing the internal bumper to pass via the gastrointestinal tract. The latter approach has been widely used and is considered a safe alternative by many 53. However, there is an associated small but recognised risk of bowel obstruction 54.…”

Section: Technical Aspects Of Percutaneous Enteral Feeding Tube Placementioning

confidence: 99%

The provision of a percutaneously placed enteral tube feeding service

Westaby

Young

O'Toole

et al. 2010

Gut

105

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There is overwhelming evidence that the maintenance of enteral feeding is beneficial in patients in whom oral access has been diminished or lost. Short-term enteral access is usually achieved via naso-enteral tube placement. For longer term tube feeding there are recognised advantages for enteral feeding tubes placed percutaneously. The provision of a percutaneous enteral tube feeding service should be within the remit of the hospital nutrition support team (NST). This designated team should provide a framework for patient selection, pre-assessment and post-procedural care. Close working relations with community-based services should be established. An accredited therapeutic endoscopist should be a member of the NST and direct the technical aspects of the service. Every endoscopy unit in an acute hospital setting should provide a basic percutaneous endoscopic gastrostomy (PEG) service. This should include provision for fitting a PEG jejunal extension (PEGJ) if required. Specialist units should be identified where a more comprehensive service is provided, including direct jejunal placement (DPEJ), as well as radiological and laparoscopically placed tubes. Good understanding of the indications for percutaneous enteral tube feeding will prevent inappropriate procedures and ensure that the correct feeding route is selected at the appropriate time. Each unit should adopt and become familiar with a limited range of PEG tube equipment. Careful adherence to the important technical details of tube insertion will reduce peri-procedural complications. Post-procedural complications remain relatively common, however, and an awareness of the correct approach to managing them is essential for all clinicians involved in providing a percutaneous enteral tube feeding service. Finally, ethical considerations should always be taken into account when considering long-term enteral feeding, especially for patients with a poor quality of life.

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Section: Technical Aspects Of Percutaneous Enteral Feeding Tube Placementioning

confidence: 99%

The provision of a percutaneously placed enteral tube feeding service

Westaby

Young

O'Toole

et al. 2010

Gut

105

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“…Techniques used for PEG removal are Cut and push technique: PEG tube is cut at the skin level close to the internal bolster, which is left inside to be passed out per rectum2 3; External traction and4 Endoscopic retrieval of the internal bolster 5 …”

Section: Discussionmentioning

confidence: 99%

“…Cut and push technique: PEG tube is cut at the skin level close to the internal bolster, which is left inside to be passed out per rectum2 3;…”

Section: Discussionmentioning

confidence: 99%

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Hidden treasure in an endoscopically retrieved oesophageal trichobezoar

2013

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A 12-year-old girl with Smith-Lemli-Opitz syndrome and gastrostomy dependency presented with multiple episodes of coffee ground vomits. An upper gastrointestinal endoscopy revealed a trichobezoar in the lower oesophagus, with a ‘hidden treasure’—a retained end of a G tube at the core. Endoscopic retrieval led to resolution of symptoms. Literature is scant with only one previous report of an oesophageal trichobezoar. Techniques of removal of percutaneous endoscopic gastrostomy in children are reviewed. The pathogenesis, preventative measures and management for oesophageal trichobezoars are discussed.

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“…Previous studies recommended that patients not reporting remnant passage by day 7 have an AXR. Merrick et al 4 repeated the AXR at 2 weeks if the remnant was present on initial x‐ray but then not seen to pass. Only 1 of 42 patients required follow‐up x‐ray.…”

Section: Discussionmentioning

confidence: 99%

Complications of the Cut‐and‐Push Technique for Percutaneous Endoscopic Gastrostomy Tube Removal

Harrison¹,

Dillon

Leslie

2011

Nut in Clin Prac

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The use of the "cut-and-push" technique for percutaneous endoscopic gastrostomy (PEG) removal has been recognized since 1991. This technique is used in patients who are thought to have no risk of distal adhesions or strictures. Its use in selected patients is supported by current British Society of Gastorenterology guidelines. However, the risk of complications has long been debated. This report describes a patient who developed complications as a result of PEG removal using the cut-and-push technique. The patient had undergone previous abdominal surgery, and removal of the PEG endoscopically was not possible. A barium follow-through was performed in light of the history, and it excluded any mechanical blockage. Follow-up x-ray showed passage of the remnant beyond the pylorus. Despite this, the remnant became lodged in the small bowel, eventually resulting in perforation and death. This case highlights the fact that impaction of the remnant can occur in patients without evidence of mechanical obstruction on investigation. This raises a question about the need for serial x-rays to ensure passage of the remnant if the patient cannot confirm this visually.

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An Evaluation of the “Cut and Push” Method of Percutaneous Endoscopic Gastrostomy (PEG) Removal

Abstract: We have concluded that cut and push is a safe method of removal for Freka 15-Fr PEG tubes in ambulant patients without significant gastrointestinal history.

Cited by 17 publications

References 8 publications

The provision of a percutaneously placed enteral tube feeding service

The provision of a percutaneously placed enteral tube feeding service

Hidden treasure in an endoscopically retrieved oesophageal trichobezoar

Complications of the Cut‐and‐Push Technique for Percutaneous Endoscopic Gastrostomy Tube Removal

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