[Skin-level gastrostomy -- long-term results from a prospective trial in gastric and jejunal application]

The usefulness of skin-level gastrostomy tubes (button systems) for maintaining nutrition support after primary insertion of percutaneous endoscopic gastrostomy (PEG) is widely accepted. After first promising experiences with newly developed skin-level gastrostomy system (Freka-Button Gastrostomy) the safety and long-term stability of this new tube was not defined.

In a cohort study we prospectively evaluated from 2.1998 until 12.2001 for ease of use, complications, time to failure and long-term follow-up of 61 Freka button gastrostomies inserted in 50 patients (mean age 57.6 years, range 6 - 78 years, 44 men, 6 women). Mean time after primary PEG placement was 6.3 months (range 1 - 30 months).

Correct application of all buttons (48 gastric, 2 jejunal) was easy and fast (median time 11 minutes) to perform. In 56 % we used a new Seldinger guide wire technique to improve stomal passage. Within the first ten days and during long-term follow-up (median 248, range 2 - 593 days) no major complication was seen. 11 systems had to be replaced mainly due to balloon failure (median 352, range 186 - 593 days). The total observation time were 15,128 days with a system failure rate of 0.26 per year.

The Freka-button systems provides an easy-to-use, safe, and feasible alternative for long-term use of skin-level gastrostomy. First jejunal application of this new device was promising but needs further evaluation.