Feeding gastrostomy button: experience and recommendations

To circumvent the common problems and complications of long-term gastrostomy management, a skin-level nonrefluxing nonreactive gastrostomy "button" (GB) was designed. This silicon device is self-retaining, employing a one-way (in) valve. For feeding purposes, an adapter is inserted. Since initial results with five prototypes were encouraging, our experience with 90 buttons over a 20-month period forms the basis of this report. The GB is commercially available in three sizes: "small" (1.5 cm shaft length), medium (2.7 cm), and long (4.3 cm). A new narrow shafted prototype with an intermediary shaft length of 2.3 cm is under evaluation. We have analyzed our experience with the GB in 50 children (average age 4.1 years, average weight 12.8 kg) and six adults (average age 75 years) during this span. Ninety GBs were employed (small 46, medium 31, long 7, prototype 6) for a total of 485 patient months. In the pediatric age group, the average time with one or more GBs in place was 8.9 months. Of the 50 children, 30 had one GB only, 11 had two, six had three, and three had four GBs (total 82 GBs). The performance of each GB was under 1 month, 3 (mechanically defective); 1 to 3 months, 20; 3 to 6 months, 25; 6 to 12 months, 26; and over 12 months, 8 (two at 20 months). There were 31 changes in 20 children: leakage through GB shaft, 23 (valve incompetence); accidentally pulled out, 4; leakage around shaft (poor stoma), 2; and deterioration at feeding connection end, 2. One additional GB was purposely temporarily removed when the child underwent a colostomy closure. Seven GBs in children were removed since they were no longer needed. In two children, the GBs were replaced by a conventional catheter at 1 and 6 months post-GB insertion (chronic intermittent bowel obstruction requiring frequent drainage in one and multiple removals of the GB by the child in the other). Difficulties with early feeding adapters (frequent disconnections or shaft stretching) were encountered in five, but this is no longer a problem.(ABSTRACT TRUNCATED AT 250 WORDS)