Department of Paediatric Surgery and Urology, Southampton Children's Hospital, 18 Woodham Park Road, Woodham, Addlestone, Surrey, Southampton, KT153ST, UK.
University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
Pediatr Surg Int. 2023 Jan 30;39(1):94. doi: 10.1007/s00383-023-05382-5.
Percutaneous Endoscopically placed Gastrostomy (PEG) tubes are frequently used in children. The traditional endoscopic method to remove/change the PEG device requires general anaesthesia in children. A minimally invasive alternative is the 'Cut and Push' method (C&P): avoiding the risks/wait times of general anaesthesia and reducing resource burden. Data regarding the safety/effectiveness of C&P in children are lacking with concerns raised about the possibility of gastrointestinal obstruction.
We retrospectively reviewed all cases of PEG removal / change to button in children (< 18 years) between December 2020 and January 2022. Cases were identified from a prospectively maintained database and all cases of C&P included. Parents/carers were asked if the child had suffered any complications following C&P and if flange was visualised in stools.
During the time period, 27 PEGs were either removed or changed to button via C&P. The average waiting time for C&P was 14.29 days, significantly shorter than the minimum 6-month waiting time for elective endoscopy. Our evaluation revealed no complications of C&P at median 70 days (range 25-301). In three cases the flange was visualised in the stool, at 2 days, 3 days and 5 weeks following C&P respectively.
These data support the available literature suggesting C&P is an effective means to facilitate minimally invasive and prompt PEG removal/change to button in children. We recommend minimum weight and age parameters for this procedure and further evaluation of the safety and resource implications of this technique.
经皮内镜下胃造口术（PEG）管在儿童中经常使用。传统的内镜方法需要对儿童进行全身麻醉来移除/更换 PEG 装置。一种微创替代方法是“切割和推送”方法（C&P）：避免全身麻醉的风险/等待时间，并减少资源负担。缺乏关于儿童 C&P 的安全性/有效性的数据，有人担心可能会发生胃肠道梗阻。
我们回顾性分析了 2020 年 12 月至 2022 年 1 月期间所有接受 PEG 移除/更换为纽扣的儿童（<18 岁）病例。病例从一个前瞻性维护的数据库中确定，所有 C&P 病例均包括在内。询问家长/照顾者在 C&P 后儿童是否有任何并发症，以及法兰是否在粪便中可见。
在研究期间，27 例 PEG 经 C&P 被移除或更换为纽扣。C&P 的平均等待时间为 14.29 天，明显短于择期内镜检查的最短 6 个月等待时间。我们的评估发现，在中位 70 天（范围 25-301 天）时，没有 C&P 的并发症。在 3 例中，在 C&P 后分别于第 2、3 和 5 周在粪便中观察到法兰。
这些数据支持现有文献，表明 C&P 是一种有效的方法，可以促进儿童微创和及时的 PEG 移除/更换为纽扣。我们建议为该手术规定最小的体重和年龄参数，并进一步评估该技术的安全性和资源影响。
