A simple method for percutaneous endoscopic gastrostomy tube removal: "tie and retrograde pull".
OBJECTIVE
Various techniques have been presented to remove the percutaneous endoscopically placed gastrostomy tube in children, but tubes with semi-rigid internal retaining discs are difficult or impossible to remove by external traction. We describe a simple and effective endoscopic removal technique that should be applicable to any type of percutaneous endoscopic gastrostomy tube.


METHODS
Percutaneous endoscopic gastrostomy tube removal was performed with the "tie and retrograde pull" technique. After a polypropylene suture was placed and tied 1cm over the skin level, the percutaneous endoscopic gastrostomy tube was cut 0.5 cm over the knot. The suture was cut from the connection point between the needle and the suture. The distal end of the suture was pushed through the stoma into the stomach. Then a forceps was inserted through the gastroscope. The suture was caught, and the residual percutaneous endoscopic gastrostomy portion was retrieved via retrograde traction on the suture.


RESULTS
The causes of exchange were determined to be planned tube replacement in 9, buried bumper syndrome in 1, and tube occlusion in 3 patients. The mean tube dwell time was 10.8 ± 3.9 months. Esophageal mucosal tear developed in 1 patient with epidermolysis bullosa during removal. No other complications occurred during PEG tube exchanges.


CONCLUSIONS
This is a rapid and useful technique that does not require any complex endoscopic devices.
Gaziantep Children Hospital, Department of Pediatric Surgery, Gaziantep, Turkey. sckarakus@yahoo.com
Suleyman Cuneyt
SC
Karakus
Coskun
C
Celtik
Naim
N
Koku
Idris
I
Ertaskın
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000379:methods*; D004750:Enteral Nutrition; D004820:Epidermolysis Bullosa / Q000150:complications / Q000628:therapy; D004947:Esophagus / Q000293:injuries; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000295:instrumentation*; D006801:Humans; D007223:Infant; D008297:Male; D054047:Surgical Stomas; D013536:Suture Techniques
Epidermolysis bullosa; Percutaneous endoscopic gastrostomy; Percutaneous endoscopic gastrostomy catheter removal, buried bumper syndrome