Removal of PEG using the cut and push method

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What is the cut and push method?

Cut and push is a method of removing a percutaneous endoscopic gastrostomy (PEG) without the need for endoscopy.

Why do I need it?

Your consultant has decided it would be safer for you to have this procedure to remove your PEG.

Who will do the procedure?

A nutrition nurse specialist, gastroenterology registrar or gastroenterology consultant can perform this procedure.

How is the cut and push completed?

The triangle plate is released and moved toward the length of the tube. The tube is then held firmly upwards and then cut close to the skin. The circular disc on the inside is then pushed into your stomach. It is a small white disc, the size of a 10p piece.

• A dressing will be placed over the site.
• No sedation is required

Are there any risks with the ‘cut and push’ method of removal?

There is a very small risk that the internal disc could get stuck in the bowel. This could then cause an obstruction and would require urgent medical attention. For this reason, before the procedure this is discussed at our weekly MDT meeting.

The nutrition nurses will ask you the following questions:

• Have you previously had any abdominal/ bowel surgery?
• Do you have inflammatory bowel disease (Crohn’s disease or ulcerative colitis)?
• Do you regularly suffer from constipation?

If you answer 'yes' to any of the above, the consultant may decide that the ‘cut and push’ method of removal is not suitable for you. The PEG can then be removed endoscopically.

What do I need to do in preparation for the procedure?

• Check that your PEG is advancing and rotating 360 degrees and, if it is not, inform the doctor before the procedure.
• Ensure that you have not eaten or had any feed via your PEG for six hours prior to the procedure.
• Ensure that you have not had any fluid orally or via your PEG for two hours prior to the procedure.

Replacement gastrostomy (if applicable)

A balloon retained gastrostomy may be inserted in its place if required. The nutrition nurse will discuss this with you before your appointment if it is required.

Will I need to be admitted to hospital?

No, this procedure will not require an admission to hospital. It can be carried out in the outpatient clinic. It would be advisable to set aside an hour for the appointment.

What must I do after the procedure?

Please do not eat and drink for two (2) hours after the procedure. After this time you can eat and drink normally.

For replacement gastrostomy placement only

If a new balloon gastrostomy tube has been inserted immediately after this procedure then you will be able to use it for feeding, medication and water flushes as long as you have been told that the tube is in the correct position.

Site healing

If a tube is not inserted following the procedure, to allow the site to heal, do not bathe or shower for three days, and do not swim for seven days.

What else do I need to look out for?

It is important you keep a watch for the internal bumper (a small white disc, the size of a 10p piece) to pass during one of your bowel motions. (It may take a few days for this to pass through.)

When to contact your GP or nutrition nurse

• If the PEG site continues to leak after seven days and the dressing needs to be changed frequently.
• If you have a temperature as this may indicate an infection.

If you have any of the following symptoms go to your local accident and emergency department

• Bloated, tender and painful
• Vomiting
• Constipation

It would be useful to let them know your PEG was removed as an urgent imaging of your abdomen will be required.