Primary percutaneous endoscopic button gastrostomy: a modification of the “push” technique

Abstract

Percutaneous endoscopic gastrostomy (PEG) in children has important advantages over an open procedure. Since the original description by Gauderer and associates, there have been several modifications to the procedure. These have included laparoscopyassisted percutaneous gastrostomy, fluoroscopically guided percutaneous gastrostomy, and primary placement of a button gastrostomy. One of the most important modifications of PEG placement has been the “push” technique. This technique reduces the incidence of wound infections and esophageal injuries because the gastrostomy is not pulled through the oral cavity and the esophagus is instrumented only once. Additionally, by primarily placing the MIC-KEY gastrostomy (Ballard Medical Products, Draper, UT), a second procedure to replace a tube gastrostomy with a more permanent MIC-KEY is unnecessary. We report a modification of the techniques described by Stylianos and Flanigan and by Robertson and colleagues. We have performed primary placement of MIC-KEY gastrostomies using the “push” technique in six patients without perioperative complications.