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Primary Gastrostomy Button Placement in Children Using a Percutaneous Endoscopic Technique: a Prospective Analysis
*Jessica I. Abrantes1,2, *Christine M. Rader1,2, Brendan T Campbell1,2
1Connecticut Children's Medical Center, Hartford, CT;2University of Connecticut School of Medicine, Farmington, CT

Objective: To describe the efficacy and safety of the Microvasive One Step ButtonTM system for primary placement of low profile gastrostomy buttons in children using a percutaneous endoscopic (PEG) technique.
Design: Prospective, single center study.
Setting: Free standing academic children’s hospital.
Patients: Eighty-eight consecutive patients requiring enteral access underwent gastrostomy tube placement using this technique from February 2009 through April 2012.
Interventions: Gastrostomy buttons were placed using the “pull” technique, and then control gastroscopy was performed to confirm intraluminal tube position. Laparoscopic guidance was utilized in 6 patients. Feeds were initiated on post-operative day one.
Main Outcome Measures: Major and minor complications within 90 days of procedure.
Results: Eighty-eight consecutive patients underwent endoscopic placement of low-profile gastrostomy tubes. Mean age was 40.8±69.0 months, and 52.3% (n=46) were female. Mean weight was 12.8±16.0 kilograms, and nearly half (47.7%) weighed less than 5 kilograms. Mean operative time was 20±7 minutes. None of the procedures were aborted or converted to an alternative approach. Major post-operative complications occurred in 8 patients (9.1%): colon injury (n=1, 1.1%), tube dislodgement (n=5, 5.7%), infected hydrocele (n=1, 1.1%), and worsening reflux requiring fundoplication (n=1, 1.1%). All dislodged tubes were repositioned under anesthesia using Mic-KeyTM buttons and endoscopic or fluoroscopic guidance. Minor complications included granuloma formation (n=10, 11.4%), cellulitis (n=5, 5.7%) and mechanical malfunction (n=1, 1.1%). There were no cases of esophageal or gastric perforation, major bleeding, or death. Gastrostomy tubes were first exchanged at least eight weeks following initial placement.
Conclusion: This technique is a safe option for primary button placement in pediatric patients including neonates. Advantages include primary button placement, short duration of anesthesia, sutureless technique, and an acceptable complication profile.

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