Nonendoscopic removal of percutaneous endoscopic gastrostomy tubes: Morbidity and mortality in children

Background: Percutaneous endoscopic gastrostomy (PEG) tubes are often removed by cutting the tubing at skin level and allowing the internal components to pass through the gastrointestinal tract. This technique is commonly used in adults, but little information is available concerning its safety in younger patients. Methods: To assess the safety of this approach in children, the clinical courses of all patients who had undergone PEG tube removal in our pediatric gastroenterology unit over a 3-year period were reviewed. Results: Five of 11 patients in whom the internal components were allowed to pass developed significant complications. Three required subsequent endoscopic removal of the internal component due to persistent vomiting, one died from complications of esophageal perforation caused by the retained internal component, and one developed a gastrocutaneous fistula containing the. retained bumper 2 years after PEG tube removal. Significant complications occurred more often in the younger and smaller patients. Conclusions: Small children are at greater risk than adults for developing serious complications associated with unremoved PEG tube internal components. If passage of the internal components cannot be confirmed after 2 weeks, chest and abdominal radiographs should be obtained.