title: Feasibility of the cut-and-push method for removing large-caliber soft percutaneous endoscopic gastrostomy devices.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) is the method of choice for long-term nutrition in patients with longstanding eating difficulties due to pathological entities that impair swallowing. The feeding catheters are designed to be removed by external traction or by endoscopy.
  
  
  OBJECTIVE
  To evaluate the feasibility of the cut-and-push method as a possible safe alternative to the pullout method for removal of soft PEG devices with a large caliber.
  
  
  METHODS
  Patients with 20 French (Fr) or larger soft PEG system were enrolled for PEG removal by the cut-and-push technique. The replacement catheters were 2 Fr larger than the original ones. Patients were observed at 24 and 72 hours via home nursing care and then weekly for 1 month for signs of intestinal obstruction, tube leakage, or blockage.
  
  
  RESULTS
  Seventy-nine patients (52 men; mean age 67 years) underwent the procedure: 42 due to leakage and 37 due to blockage. Mean time before tube removal was 4.8 months (range, 3-8). PEG devices were 20 Fr and 24 Fr in 57 (72.2%) and 22 (27.8%) cases, respectively. Collection of the inner component from stool was reported within 48 hours in 63 cases (80%). No cases of intestinal obstruction or other severe adverse events due to the inner component being eliminated throughout the intestine were observed in any patient during the study.
  
  
  CONCLUSIONS
  The cut-and-push method employed for removal of a soft PEG tube with a large caliber seems to be safe and can be performed when removal by external traction may determine the occurrence of peristomal complications or jeopardize PEG replacement.
authors.affiliation: Department of Internal Medicine, King Fahad Hospital, Armed Forces Hospitals Southern Region, Khamis Mushyt, Kingdom of Saudi Arabia.
authors.forename: Adnan
authors.initials: A
authors.lastname: Agha
authors.forename: Dib
authors.initials: D
authors.lastname: AlSaudi
authors.forename: Manuele
authors.initials: M
authors.lastname: Furnari
authors.forename: Mamdouh M
authors.initials: MM
authors.lastname: Abdulhadi Ali
authors.forename: Rafaat
authors.initials: R
authors.lastname: Morched Chakik
authors.forename: Islam
authors.initials: I
authors.lastname: Alsaudi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057785:Catheters; D003672:Defecation; D003680:Deglutition Disorders / Q000628:therapy; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005773:Gastroscopy / Q000295:instrumentation*; D005774:Gastrostomy / Q000295:instrumentation*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged
keywords: enteral nutrition; gastrostomy