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July 10, 1991

Relative Merits of Techniques for Gastrostomy Tube Removal-Reply

JAMA. 1991;266(2):217. doi:10.1001/jama.1991.03470020043025

In Reply.  —We agree with Ayre-Smith that radiologic placement of a balloon catheter is a suitable option and cite the experience of Russell et al1 in the introductory paragraphs of our article. Since we believe that PEGs are placed more frequently by endoscopists than by radiologists nationwide, the purpose of our article was to demonstrate the safety of removal by simple nonendoscopic means. The issues of cost comparisons, safety, duration of the procedure, and ease of performance between endoscopic and radiologic PEG placement are not relevant to the results of our study.In response to Winograd's comments, we reiterate that our study was carried out to determine the safety of nonendoscopic removal. That the "considerable cost" of transporting patients for one or two serial abdominal radiographs to confirm elimination of the internal PEG components justifies endoscopic removal is not a valid argument in our view. We recognize that internal