title: The "cut and push" method of percutaneous endoscopic gastrostomy tube removal in adult patients: the Ipswich experience.
abstract: BACKGROUND
  The standard method of removing percutaneous endoscopic gastrostomy (PEG) tubes in the United Kingdom is by repeat gastroscopy and retrieval of the internal PEG bumper by the oral route. However, the endoscopic removal method may not always be necessary by use of the "cut and push" method. This involves cutting the tube at skin level and allowing the internal bumper to pass naturally.
  
  
  METHODS
  A local database of all patients undergoing a PEG insertion was created in February 2002. All PEG tube removals by the "cut and push" method over a 5-year period at Ipswich Hospital were reviewed.
  
  
  RESULTS
  Between February 2002 and December 2007, 89 Fresenius Freka 15 Fr tubes were removed by the "cut and push" method. The original indications for the PEG tubes that were removed were head and neck malignancy (55), cerebrovascular accident (24), and other miscellaneous causes (10). The mean age of the patients was 62.7 years (range 19-98 years). The average duration of the tube in-situ before removal was 6.7 months (range 1-28). No complications were recorded during the mean follow-up period of 26.8 months (range 1-66 months).
  
  
  CONCLUSIONS
  Follow-up data provide further evidence that the "cut and push" method is a safe and cost-effective method for removing 15 Fr PEG tubes in adult patients and that an abdominal radiograph is not routinely required.
authors.affiliation: Department of Gastroenterology, Ipswich Hospital NHS Trust, Ipswich, UK. d_kejariwal@yahoo.com
authors.forename: Deepak
authors.initials: D
authors.lastname: Kejariwal
authors.forename: Dawn
authors.initials: D
authors.lastname: Bromley
authors.forename: Y
authors.initials: Y
authors.lastname: Miao