title: Traction removal of percutaneous endoscopic gastrostomy devices in children.
abstract: BACKGROUND
  There are few published data on non-endoscopic removal of percutaneous endoscopic gastrostomy devices in children.
  
  
  OBJECTIVE
  To describe prospective data acquired for traction removal of percutaneous endoscopic gastrostomy devices at a single pediatric center over a 5-year period.
  
  
  METHODS
  Data were obtained from endoscopy records, computerized hospital patient information systems and case note analysis. The device that could be removed by traction was the Corflo (Merck) 12-Fr percutaneous endoscopic gastrostomy tube with a collapsible internal retention dome. All procedures were performed under general anesthesia.
  
  
  RESULTS
  Between 2002-2006, 220 children underwent percutaneous endoscopic gastrostomy removals (166 by traction, 51 endoscopically and 3 Foley catheter to button conversions). The median duration between percutaneous endoscopic gastrostomy insertion and low profile button device substitution was 0.83 years (0.12-3.86). Complications from traction removal included internal retention dome separation in two cases (allowed to pass per rectum, uneventfully), failure to a insert a low profile button device needing percutaneous endoscopic gastrostomy reinsertion, enterocutaneous fistula requiring surgical closure in one patient and laparoscopy for suspected low profile button device misplacement in one instance. The material cost of endoscope disinfection (£10) and disposable usage (£80) avoided by traction removal was calculated at £90 per procedure.
  
  
  CONCLUSIONS
  No mortality occurred as a result of the traction removal of percutaneous endoscopic gastrostomy tubes. Laparoscopy for suspected low profile button device misplacement was needed in one case (0.60%). Traction removal of percutaneous endoscopic gastrostomy tubes was generally safe and a cost-saving procedure in our experience.
authors.affiliation: Department of Pediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK. ramsriniv@doctors.org.uk
authors.forename: Ramesh
authors.initials: R
authors.lastname: Srinivasan
authors.forename: Tracey
authors.initials: T
authors.lastname: Irvine
authors.forename: A M
authors.initials: AM
authors.lastname: Dalzell
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D000818:Animals; D002648:Child; D003362:Cost-Benefit Analysis; D020878:Device Removal / Q000191:economics / Q000379:methods* / Q000451:nursing; D016099:Endoscopy, Gastrointestinal; D005260:Female; D013271:Gastric Dilatation; D005774:Gastrostomy / Q000191:economics / Q000379:methods* / Q000451:nursing; D006801:Humans; D010535:Laparoscopy; D008297:Male; D016347:Medical Records Systems, Computerized; D011446:Prospective Studies; D013041:Specialties, Nursing / Q000379:methods*; D014143:Traction / Q000191:economics / Q000379:methods* / Q000451:nursing