Nonendoscopic removal of percutaneous endoscopic gastrostomy tubes: morbidity and mortality in children

Yaseen, Mohammed; Steele, Marilyn I.; Grunow, John E.

doi:10.1016/s0016-5107(96)70157-8

Cited by 45 publications

(22 citation statements)

References 11 publications

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“…A number of complications related to removal of the PEG are recognised [1][2][3][4][5][6]. These have primarily been due to retention within the bowel of components of the PEG, consisting either of remnants of broken tubes or, more commonly, of detachable internal retaining crossbars [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…These have primarily been due to retention within the bowel of components of the PEG, consisting either of remnants of broken tubes or, more commonly, of detachable internal retaining crossbars [2][3][4][5]. Indeed, PEGs have been removed by traction, by cutting the tube at the skin level [5] or by using devices assembled with an internal detachable crossbar, which slid off the tube when this was pulled out [1,4].…”

Section: Discussionmentioning

confidence: 99%

“…Remnants left within the stomach can fail to pass through the gastrointestinal tract in children and can lodge at different sites causing untoward outcomes such as persistent vomiting, bowel obstruction and bowel perforation [2,4,5]. However the most severe complications have occurred following proximal migration of the remnants into the oesophagus [3][4][5] and include oesophageal stricture and death. It is now accepted that PEG removal must be complete and no remnant should be left behind [2,5].…”

Section: Discussionmentioning

confidence: 99%

“…A number of complications have been associated with insertion as well as removal or change of PEG to another gastrostomy device [1][2][3][4][5]. Attention must be paid to technical details in order to avoid or treat appropriately such complications [6].…”

Section: Introductionmentioning

confidence: 99%

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A simple adjunct for safer change of PEG

Castagnetti

Patel

2006

Ped Surgery Int

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Percutaneous endoscopic gastrostomy (PEG) is a procedure commonly performed in children who require long-term enteral nutritional support. Although simple, PEG insertion carries the risk of severe and potentially life-threatening complications. Attention to detail is paramount in preventing such complications. Removal is also associated with complications. We describe a simple and inexpensive technique, just requiring a loop nylon suture, which is a useful adjunct to standard endoscopic removal or change of PEG. This modified technique is particularly useful in the untoward event of gastric separation from the anterior abdominal wall during gastrostomy tract dilatation or insertion of the new button device.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A simple adjunct for safer change of PEG

Castagnetti

Patel

2006

Ped Surgery Int

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“…This is commonly performed in adult practice, but is generally thought to be unacceptable in children due to risks of esophageal and intestinal obstruction. Esophageal obstruction, perforation, mediastinitis, retropharyngeal abscess formation, gastric outlet, intestinal and ileostomy obstruction, enterocutaneous fistula formation, tract disruption and death have been variously described with PEG removal (Yaseen et al, 1996, Siegel and Douglass, 2004, Palmer et al, 2006, Mollitt et al, 1998, Lattuneddu et al, 2003, Kobak et al, 2000, El-Rifai et al, 2004. Traction removal is performed under general anesthesia in children and involves application of a significant pulling force to deliver the device in full.…”

Section: Replacement Of the Peg Tubementioning

confidence: 99%

Percutaneous Endoscopic Gastrostomy in Pediatric Patients

Saadah¹

2011

Gastrostomy

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Complications of Removing Percutaneous Endoscopic Gastrostomy Tubes in Children

Kobak,

McClenathan,

Schurman

2000

J. pediatr. gastroenterol. nutr.

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Background:Little information has been reported regarding the frequency and type of complications arising from removal of percutaneous endoscopic gastrostomy (PEG) tubes in children.Methods:The records of 397 patients who had PEG tubes placed from 1993 through 1998 were reviewed for complications after removal. Data collected included length of time the tube was in place, age of the patient at insertion, type of tube removed, and patient diagnosis.Results:Fifty‐four children had the PEG tube removed by traction or endoscopy. The only complication was persistent leaking through a gastrocutaneous fistula in 13 patients (24%). Leaking ceased in 6 children coincident with H2‐antagonist therapy and silver nitrate cautery, and surgical closure of the fistula was required in 7 patients. Comparison of these 7 children with those who did not require surgery (n = 47) showed a longer duration of tube placement (mean ± SE of 20.6 ± 3.6 months, range 11–31 months vs. 11.1 ± 1.3 months, range 1–35 months;P < 0.05). Further analysis showed no child with a PEG tube removed before 11 months (n = 23) after insertion required surgery, whereas 7 (23%) of 31 children with a PEG tube removed after 11 or more months required surgery. Age at insertion, type of feeding device removed, and patient diagnoses were not different between the two groups.Conclusions:These data indicate that persistent leaking necessitating surgical closure of a gastrocutaneous fistula does not occur in children with a PEG tube removed within 11 months of insertion. In contrast, 23% of children with a PEG tube removed 11 or more months after insertion require surgery. In patients identified as candidates for tube removal, this time frame may be important in clinical decision making.

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Nonendoscopic removal of percutaneous endoscopic gastrostomy tubes: morbidity and mortality in children

Cited by 45 publications

References 11 publications

A simple adjunct for safer change of PEG

A simple adjunct for safer change of PEG

Percutaneous Endoscopic Gastrostomy in Pediatric Patients

Complications of Removing Percutaneous Endoscopic Gastrostomy Tubes in Children

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