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Reminder of important clinical lesson
The ‘cut and push’ technique: is it really safe?
  1. Oliver Peacock1,
  2. Rajeev Singh2,
  3. Andrew Cole3,
  4. William Speake1
  1. 1Department of General Surgery, Royal Derby Hospital, Derby, UK
  2. 2Department of Radiology, Royal Derby Hospital, Derby, UK
  3. 3Department of Gastroenterolog, Royal Derby Hospital, Derby, UK
  1. Correspondence to
    Oliver Peacock, oliver.peacock{at}

Percutaneous endoscopic gastrostomy (PEG) feeding is routinely used as an endoscopic and effective method for providing enteral nutrition in those whose oral access has been diminished or lost. One technique for removal of the PEG is cutting the tube at the skin level and allowing the tube and internal flange to pass spontaneously. This is known as the ‘cut and push’ method. Several studies have concluded that the ‘cut and push’ method is a safe and cost-effective method. This case demonstrates a rare cause of small bowel obstruction following the ‘cut and push’ method for PEG replacement, with only a few other cases been reported. This method of removal should be avoided in patients with previous abdominal surgery. It is important that the PEG flange is retrieved endoscopically or an alternative PEG tube (designed to be completely removed through the skin) is used to prevent this complication occurring in such individuals.

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  • Competing interests None.

  • Patient consent Obtained.

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