One-Step Insertion of Low-Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy: Retrospective Analysis of Outcomes

JPEN J Parenter Enteral Nutr. 2016 Mar;40(3):423-30. doi: 10.1177/0148607114567202. Epub 2015 Jan 13.


Background: Standard care for initiation of enteral feeding in children has been pull percutaneous endoscopic gastrostomy (pull-PEG). As an alternative to pull-PEG, a 1-step endoscopic procedure for inserting a low-profile gastrostomy tube "button" has been developed that allows initial placement of a balloon-retained device. This report presents outcomes of metrics used to compare button placement with pull-PEG in a pediatric population.

Methods: Data were generated from procedural experiences of surgeons on pediatric patients (n = 374) with a variety of clinical indications for gastrostomy. Study population ages ranged from 6 days to 16 years, while weights were from 2-84 kg.

Results: The button was successfully placed by the 1-step procedure in 98% of the respective study population, and median procedural times were 20 and 15 minutes for button and pull-PEG placements, respectively. Median times to first feeds were equivalent for the 1-step procedure and pull-PEG (6 hours), while times to first nutrition feeds were 12.5 and 10 hours, respectively. Stoma site complications within each study group were similar. Healthy stoma proportions were 65.2% and 73.2% in the 1-step procedure and pull-PEG groups, respectively, at first follow-up.

Conclusions: Similar study outcomes between the 1-step procedure and pull-PEG groups suggest that the former is a feasible alternative to pull-PEG for initial tube placement in children. The 1-step method involves a single procedure and reduces patient exposure to anesthesia, operating room time, and the potential for complications compared with a pull-PEG requirement for multiple procedures.

Keywords: button gastrostomy; enteral feeding; gastropexy; pediatric; percutaneous endoscopic gastrostomy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Body Weight
  • Catheterization
  • Child
  • Child, Preschool
  • Endoscopes, Gastrointestinal*
  • Enteral Nutrition
  • Female
  • Gastrostomy / methods*
  • Humans
  • Infant
  • Intubation, Gastrointestinal / methods*
  • Male
  • Postoperative Care
  • Retrospective Studies
  • Treatment Outcome