Should single-stage PEG buttons become the procedure of choice for PEG placement in children?

Background: Single-stage PEG buttons (PEG-B) allow initial placement of a skin-level gastrostomy device for children who require enteral access. They offer significant advantages over traditionally placed PEG tubes (PEG-T) but have not been widely accepted into practice. Objective: To review our experience with PEG-Bs compared with PEG-Ts. Hypothesis: PEG-B shares a similar safety profile with PEG-T but delays the need for an initial device change well beyond the change that usually occurs at 6 to 8 weeks after PEG-T placement. Design: Retrospective chart review. Setting: Nemours Children's Clinic, Jacksonville, Florida. Patients: All children undergoing both PEG procedures and attending our clinic from 1997 to 2002. Main Outcome Measurements: Age, sex, weight, indications, postoperative complications, interval until first tube change and first tube change complications. Results: Totals of 145 and 93 patients were identified in the PEG-B and PEG-T groups, respectively. Patient characteristics were similar in the 2 groups with respect to age, weight, indications, and postoperative complications. The interval until first tube change, however, was significantly longer in the PEG-B group (314 days) than in the PEG-T (78 days) (P < .0001). In addition, the PEG-B was found to be as safe as the PEG-T for small infants who weighed less than 5 kg. Conclusions: PEG-B placement should be considered as the procedure of choice over PEG-T placement for children. It offers similar safety profiles, even for small patients and a significantly longer interval until first device change.