University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Royal Belfast Hospital for Sick Children, Belfast, UK.
Pediatr Surg Int. 2023 Nov 22;40(1):4. doi: 10.1007/s00383-023-05575-y.
A "cut and push" (CP) approach has been described in the literature for removal of percutaneous endoscopic gastrostomy (PEG) tubes. The aim of this study is to investigate the safety profile of this method in children.
Our study included all children who underwent CP procedure for either removal or replacement of Freka PEG tube at our centre between January 2016 and August 2021. Parents contacted to establish if the internal component had been seen in the stools post-procedure. If not seen, a plain film of chest, abdomen and pelvis was arranged followed by computerised tomography (CT) scan. The presence of the internal component as a retained foreign body on imaging was evaluated along with any complication.
Of the 27 patients included, six (22.2%) patients had the internal component seen in the stool. Five (18.5%) patients in total had a retained internal component with three (11.1%) patients had major complications requiring complex surgical interventions, and two (7.4%) patients required endoscopic retrieval.
Our study reports more severe complications that required complex surgical interventions compared to the previous studies. We believe that this method of removal is not safe in children and should be abandoned. Also, patients with Down syndrome might be at higher risk of retention and complications.
文献中描述了一种“切割和推送”（CP）方法，用于移除经皮内镜胃造口术（PEG）管。本研究旨在调查该方法在儿童中的安全性。
我们的研究包括 2016 年 1 月至 2021 年 8 月期间在我们中心接受 CP 程序以移除或更换 Freka PEG 管的所有儿童。联系家长以确定内部组件是否在手术后出现在粪便中。如果未看到，则安排拍摄胸部、腹部和骨盆的平片，然后进行计算机断层扫描（CT）扫描。评估成像上内部组件是否作为残留异物存在以及任何并发症。
在 27 名纳入的患者中，有 6 名（22.2%）患者在粪便中看到了内部组件。总共有 5 名（18.5%）患者有残留的内部组件，其中 3 名（11.1%）患者出现严重并发症需要复杂的手术干预，2 名（7.4%）患者需要内镜取出。
与之前的研究相比，我们的研究报告了更严重的并发症，需要复杂的手术干预。我们认为这种移除方法在儿童中不安全，应予以摒弃。此外，唐氏综合征患者可能有更高的残留和并发症风险。
