title: Modification of the "push" technique for percutaneous endoscopic gastrostomy in infants and children.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) by the "push" technique avoids peri-catheter infection, repeated insertion of the endoscope, potential esophageal injury from the catheter, and the possible need for another endoscopy for catheter removal associated with the "pull" technique. In small infants, however, the "push" technique could result in loss of gastric insufflation and pneumoperitoneum during tract dilatation. A simple modification of the "push" technique has eliminated this problem.
  
  
  METHODS
  During a 16-month period, 22 infants and children underwent PEG insertion using our modified "push" technique. These cases were reviewed for patient characteristics including age, weight, indication for the procedure, duration of the procedure, cost, conversion to open technique, and complications.
  
  
  RESULTS
  We have used the modified "push" technique to place PEG tubes in 20 infants and children aged four weeks to 15 years (mean, 13 months), weighing 2.7 to 36 kg (median, 6.0 kg), indicated for failure to thrive due to cystic fibrosis (n=3) or neurologic impairment (n=10). These patients have had follow-up examination from nine to 30 months after the procedure. Operative time averaged 15 minutes. The "push" technique was successful in 95 percent of patients with one failure caused by loss of gastric insufflation when Fogarty balloons failed. All PEGs were used within 24 hours. There were no deaths and no peri-catheter infections.
  
  
  CONCLUSIONS
  A simple modification of the "push" technique of PEG insertion eliminated problems with loss of gastric insufflation previously encountered in small infants. The modified "push" technique is safe, simple, and quick, obviating potential risks inherent in the "pull" technique when applied in infants.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Tufts University School of Medicine, Boston, MA USA.
authors.forename: F M
authors.initials: FM
authors.lastname: Robertson
authors.forename: T M
authors.initials: TM
authors.lastname: Crombleholme
authors.forename: L A
authors.initials: LA
authors.lastname: Latchaw
authors.forename: N N
authors.initials: NN
authors.lastname: Jacir
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000191:economics / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004750:Enteral Nutrition / Q000191:economics / Q000379:methods; D020699:Gastroscopes; D005773:Gastroscopy / Q000191:economics / Q000379:methods*; D005774:Gastrostomy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007223:Infant