Gastrostomy button placement through percutaneous gastrostomy tracts created with fluoroscopic guidance: experience in 27 children.
OBJECTIVE
The authors report their experience with skin level (button) gastrostomy placement through radiologically created gastrostomy tracts.


METHODS
Fifty-two gastrostomy buttons have been placed in 27 children (average age, 73 months; range, 9-235 months). All buttons were placed through tracts created during earlier fluoroscopically guided percutaneous gastrostomy. Fifteen Bard mushroom-type buttons and 12 MIC-Key balloon-type buttons were initially placed. Patients have been followed up for an average of 13.4 months.


RESULTS
Button placement was successful at the initial attempt in 25 of 27 patients (93%). Tract age at button placement averaged 18.5 weeks. The average tract length measured 3.5 cm (1.7-6.0 cm). Tract rupture and peritoneal leakage occurred in three patients; one patient had the button immediately repositioned without sequela, and the remaining two patients underwent replacement of the gastrostomy tube into the stomach and successful button placement approximately 1 week later. There were no major complications. Minor problems (leak, granulation tissue, valve malfunction, balloon breakage) occurred in 19 patients.


CONCLUSIONS
Button gastrostomy is a useful alternative to the traditional gastrostomy tube for the pediatric population. Conversion with use of existing radiologically created tracts is possible and safe. Attention to tract integrity and proper button position is required to avoid complications.
Borge
M A
MA
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Vesely
T M
TM
Picus
D
D
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D010532:Peritoneal Diseases / Q000209:etiology; D011446:Prospective Studies; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013499:Surface Properties; D016896:Treatment Outcome