title: Endoscopic button gastrostomy: Comparing a sutured endoscopic approach to the current techniques.
abstract: OBJECTIVE
  Button gastrostomy is the preferred feeding device in children and can be placed open or laparoscopically (LBG). Alternatively, a percutaneous endoscopic gastrostomy (PEG) can be placed initially and exchanged for a button. Endoscopic-assisted button gastrostomy (EBG) combines both techniques, using only one incision and suturing the stomach to the abdominal wall. The long-term outcomes and potential costs for EBG were compared to other techniques.
  
  
  METHODS
  Children undergoing EBG, LBG, and PEG (2010-2013) were compared. Patient demographics, procedure duration/complications, and clinic and emergency room (ER) visits for an eight-week follow-up period were compared.
  
  
  RESULTS
  Patient demographics were similar (32 patients/group). Mean procedure time (min) for EBG was 38 ± 9, compared to 58 ± 20 for LBG and 31 ± 10 for PEG (p<0.0001). The most common complications were granulation tissue and infection with a trend toward fewer infections in EBG group. Average number of ER visits was similar, but PEG group had fewer clinic visits. 97% of PEG patients had subsequent visits for exchange to button gastrostomy.
  
  
  CONCLUSIONS
  EBG is safe and comparable to LBG and PEG in terms of complications. It has a shorter procedure time than LBG and does not require laparoscopy, device exchange, or subsequent fluoroscopic confirmation, potentially reducing costs.
authors.affiliation: Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gonzalez-Hernandez
authors.affiliation: Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Daoud
authors.affiliation: Department of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI, USA.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Fischer
authors.affiliation: Division of Gastroenterology, University of Texas Southwestern/Children's Health, Children's Medical Center, Dallas, TX, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Barth
authors.affiliation: Division of Pediatric Surgery, University of Texas Southwestern/Children's Health, Children's Medical Center, Dallas, TX, USA. Electronic address: Hannah.Piper@childrens.com.
authors.forename: Hannah G
authors.initials: HG
authors.lastname: Piper
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000191:economics / Q000295:instrumentation / Q000379:methods; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D012189:Retrospective Studies; D013536:Suture Techniques; D013781:Texas
keywords: Button gastrostomy; Laparoscopic gastrostomy; Percutaneous endoscopic gastrostomy