title: "Push-pull" gastrostomy: a new technique for percutaneous gastrostomy tube insertion in the neonate and young infant.
abstract: OBJECTIVE
  To evaluate a newly developed method combining antegrade and retrograde techniques for percutaneous gastrostomy tube (PGT) insertion in the neonate and young infant.
  
  
  METHODS
  From January 1994 to December 2000, 85 children (47 male, 38 female), mean age 4.5 months (range 0.44-9.13 months) underwent PGT insertion using the "push-pull" technique. With the addition, 57 children had a jejunostomy tube placed as well at or within 24 h of the PGT procedure. The mean weight was 3.74 kg, range 1.5-7.0 kg. The indications for the procedure included failure to thrive in 40 patients (25%), static encephalopathy in 21 (25%), neurological/congenital abnormalities in 12 (14%), aspiration in 7 (8%), and cardiac problems in 5 (6%).
  
  
  RESULTS
  Eighty-five PGTs were successfully inserted in 85 children. One procedure was initially unsuccessful due to failed conscious sedation and was completed under general anesthesia. Four of 85 patients initially had attempted antegrade placement that failed, and the procedure was successfully completed using the "push-pull" method. One major complication occurred: a gastrocolic fistula at day 5 post-procedure, which was surgically repaired without sequelae. Tube-related problems included; tube dislodgement (n = 1) and procedure-related stomal infection (n = 3).
  
  
  CONCLUSIONS
  The "push-pull" gastrostomy technique is a safe, effective method of percutaneous gastrostomy tube placement in neonates. It facilitates successful placement of the PGT in patients in whom the classic antegrade method is not possible. It has become the procedure of choice in this group.
authors.affiliation: Children's Hospital of Pittsburgh, Department of Radiology, PA 15217, USA. Cahilla@chplink.chp.edu
authors.forename: A M
authors.initials: AM
authors.lastname: Cahill
authors.forename: R D
authors.initials: RD
authors.lastname: Kaye
authors.forename: C R
authors.initials: CR
authors.lastname: Fitz
authors.forename: R B
authors.initials: RB
authors.lastname: Towbin
mesh_terms: D005183:Failure to Thrive / Q000628:therapy*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015641:Radiography, Interventional; D016896:Treatment Outcome