4739 Removal of peg-tubes by cutting-the-tube: shortand long-term complications.

Abstract

Background: For removal of PEG-tubes, two different techniques exist: 1. an endoscopic approach and 2. the natural passage after cutting the tube at skin level. Although the second possibility is preferred by most of the patients, complications like bowel obstruction with the need of surgery have been reported. Additionally, the long-term complications of this procedure are unknown. Methods:We performed a combined retrospective and prospective study to investigate the complications of removal of PEG-tubes by cutting. Duration of tube-passage was documented, and if natural passage was not noticed by the patient, an x-ray-examination was offered. Additionally, the further outcome of the patients was evaluated. Every patient was advised to drink at least 2000mls fluid per day, and to ensure deliberate oral food intake Results: Of 62 patients investigated (30 prospective, 32 retrospective; age: 26- 77 years, mean: 46.5 years; 82% male, 18% female; indication for PEG: Headand-Neck-Tumor: 89%, Esophagus-Tumor: 3%, Others: 8%), only 3 exhibited complications: 1 patient had abdominal pain until passage of the PEG after 4 days, and two had gastro-cutaneuos fistulas for 6 and 12 months respectively. Reasons for PEG-removal was sufficient oral intake without further need for the PEG-tube in 59/62 (95%) patients, and PEG-defect in 3 patients (5%) resulting in Button-PEG placement. Passage was noted only by 34/62 patients (55%) with a mean passage-time of 2.4 days (range: 0.5-13 days). In 11 of 28 patients, who did not notice PEG-passage, an x-ray was performed for control, but PEG-tubes could not found in any of the plain abdominal radiographs. After a mean follow-up of 38 months (range: 1-94 months), 46/59 patients (78%) are still doing well without PEG, 7 (12%) had died (4 because of the underlying disease, 3 because of other illnesses), and 6 (10%) needed a PEG-tube again because of inability of sufficient oral intake. Conclusions: Cutting-the-tube is not only easy to perform, it also seems to be safe, even if no passage of the tube is noticed by the patient. Providing bowel movements is essential to avoid bowel obstruction. In the long-term, 10% of the patients need a PEG-tube again. Therefore, indication for PEG-removal should be considered very carefully.