An evaluation of the "cut and push" method of percutaneous endoscopic gastrostomy (PEG) removal

Background: This study aimed to establish whether 15-Fr gauge percutaneous endoscopic gastrostomy (PEG) tubes can be safely removed by "cut and push." Methods: Patients were prospectively recruited who were found to be without significant intestinal dysfunction requiring removal of Freka (Fresenius Kabi) 15-Fr gauge PEG tubes. The PEG tube was cut close to the stoma and the remnant pushed into the gastric lumen with a 14-Fr nasogastric tube. Patients were asked to observe their stool for the remnant. Patients were contacted at day 7 and an abdominal x-ray was arranged for those who had not seen the remnant in the stool. If the remnant was still present as seen on plain x-ray, the patient was contacted on day 14. A second x-ray was ordered if the patient reported that they had still not seen the remnant. Outcome measures were PEG remnant observed in stool or not seen on plain abdominal x-ray, and adverse events. Results: Forty-two patients were recruited over 29 months: 38 head and neck patients and 4 others (stroke, head injury, cystic fibrosis [CF], and lung cancer). Of these, 41 had passed the remnant by day 8 and all by day 14. No adverse events occurred. Conclusions: We have concluded that cut and push is a safe method of removal for Freka 15-Fr PEG tubes in ambulant patients without significant gastrointestinal history.