PERCUTANEOUS ENDOSCOPIC PLACEMENT OF THE BUTTON GASTROSTOMY TUBE AS THE INITIAL PROCEDURE IN INFANTS AND CHILDREN

Percutaneous endoscopic gastrostomy (PEG) tube placement is routinely performed in children with special nutritional needs. For convenience and cosmetic reasons, many parents prefer a skin-level, nonrefluxing, (''button'') gastrostomy tube. After healing of the track, a button ga strostomy tube can replace a PEG but this requires a second procedure. This study assessed the technique and complication rate of placement of a button gastrostomy tube mounted for endoscopic placement as the i nitial procedure. Seventeen patients (10 males), ages 4 months to 12 y ears were studied. All patients underwent successful placement of the button under conscious sedation using a standard endoscopic push techn ique. In the first 10 patients, an 18 French device was used. Four pat ients developed migration of the device into the track between 9 and 5 5 days after placement and the button was removed. Migration was prece ded or accompanied by a wound infection in 3 of the 4 patients. In the next 7 patients, a larger, 24 French button was used without any woun d infections or migration of the device. In thirteen patients with suc cessful placement, a follow-up period of 110-450 days has revealed no further complications. Placement of the button gastrostomy tube in inf ants and children can be accomplished using standard endoscopic techni ques. However, further study of the optimal size of the device and opt imal placement procedure to prevent wound infection and migration shou ld be undertaken.