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

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 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 (<18yrs) 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 weeksfollowing 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.