title: One-Step Insertion of Low-Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy: Retrospective Analysis of Outcomes.
abstract: BACKGROUND
  Standard care for initiation of enteral feeding in children has been pull percutaneous endoscopic gastrostomy (pull-PEG). As an alternative to pull-PEG, a 1-step endoscopic procedure for inserting a low-profile gastrostomy tube "button" has been developed that allows initial placement of a balloon-retained device. This report presents outcomes of metrics used to compare button placement with pull-PEG in a pediatric population.
  
  
  METHODS
  Data were generated from procedural experiences of surgeons on pediatric patients (n = 374) with a variety of clinical indications for gastrostomy. Study population ages ranged from 6 days to 16 years, while weights were from 2-84 kg.
  
  
  RESULTS
  The button was successfully placed by the 1-step procedure in 98% of the respective study population, and median procedural times were 20 and 15 minutes for button and pull-PEG placements, respectively. Median times to first feeds were equivalent for the 1-step procedure and pull-PEG (6 hours), while times to first nutrition feeds were 12.5 and 10 hours, respectively. Stoma site complications within each study group were similar. Healthy stoma proportions were 65.2% and 73.2% in the 1-step procedure and pull-PEG groups, respectively, at first follow-up.
  
  
  CONCLUSIONS
  Similar study outcomes between the 1-step procedure and pull-PEG groups suggest that the former is a feasible alternative to pull-PEG for initial tube placement in children. The 1-step method involves a single procedure and reduces patient exposure to anesthesia, operating room time, and the potential for complications compared with a pull-PEG requirement for multiple procedures.
authors.affiliation: Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Göteborg, Sweden gunnar.gothberg@vgregion.se.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Göthberg
authors.affiliation: Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Sigge
authors.initials: S
authors.lastname: Björnsson
mesh_terms: D000293:Adolescent; D001835:Body Weight; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D020776:Endoscopes, Gastrointestinal; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: button gastrostomy; enteral feeding; gastropexy; pediatric; percutaneous endoscopic gastrostomy