title: De novo placement of button gastrostomy catheters in an adult population: experience in 53 patients.
abstract: OBJECTIVE
  To investigate the feasibility of primary button gastrostomy insertion with the aid of T-fastener gastropexy.
  
  
  METHODS
  Fifty-three consecutive patients (33 men, 20 women; mean age, 63.4 years) referred for percutaneous radiologic gastrostomy (PRG) underwent primary button gastrostomy insertion over an 18-month period in two centers. Nine of the patients (17%) were referred after failed endoscopic gastrostomy and 44 (83%) were primarily referred for PRG. Indications for gastrostomy included esophageal/head and neck malignancy (n = 33) and neurologic disorders (n = 20). Gastropexy with three or four T-fasteners was performed in all patients and angioplasty balloon catheters (6 mm x 40 mm) were used to measure tract length and dilate the tract. An 18-F dilator was used for final tract dilation. Button gastrostomy catheters with retention balloons were inserted in all patients. Patient follow-up was performed by the department of dietetics, which contacted patients on a weekly basis.
  
  
  RESULTS
  Primary button gastrostomy insertion was successful in 52 of 53 patients (98%). The mean gastrostomy button catheter survival was 13.3 weeks (range, 1-28 weeks). No episodes of button occlusion occurred. Since the beginning of this study, 33 patients (63%) have had their gastrostomy buttons replaced. The reasons for button replacement include burst retention balloons (n = 27; 52%), dislodgment of the catheter (n = 4; 8%), and continuing pain/discomfort at the gastrostomy site (n = 2; 4%).
  
  
  CONCLUSIONS
  Button-type gastrostomy catheters can be placed de novo by interventional radiologists without the need for a mature tract, provided a T-fastener gastropexy is used. The balloon retention button devices are not compromised by occlusion but do tend to become dislodged.
authors.affiliation: Radiology Department, Beaumont Hospital, Dublin 9, Ireland.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Lyon
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Haslam
authors.forename: Deirdre M
authors.initials: DM
authors.lastname: Duke
authors.forename: Frank P
authors.initials: FP
authors.lastname: McGrath
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional