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Updated: Jul 18, 2026

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Published on: January 27, 2010
Comparison of the Non-intubated Behavioral Pain Scale Score During Replacement of Ideal Button ZERO and Non-ZERO
Kazumi Shimamoto1, Masanori Hongo1, Naoki Dan1
1Department of Gastroenterology Omi Medical Center Kusatsu City Japan.
Objective:
Many patients report pain during bumper-type gastrostomy tube replacement. The Ideal Button ZERO (ZERO) is a 24-Fr bumper-type gastrostomy tube that was developed to eliminate such pain, but its efficacy has not yet been evaluated. We compared the pain during replacement of the ZERO and of other non-ZERO bumper-type gastrostomy tubes.
Methods:
This retrospective cohort study included 180 patients who underwent gastrostomy tube replacement at our institution during 2023-2024. The primary outcome was the Non-intubated Behavioral Pain Scale (BPS-NI) score when the gastrostomy tubes were replaced. Scores were compared among ZERO, non-ZERO 20-Fr, and non-ZERO 24-Fr groups.
Results:
Pain during gastrostomy tube removal was assessed in 80 (44.4%), 66 (36.7%), and 34 (18.9%) patients in the ZERO, non-ZERO 20-Fr, and non-ZERO 24-Fr groups, respectively. The median BPS-NI was significantly lower in the ZERO (3.0 [interquartile range [IQR]: 3.0-3.0]) than non-ZERO 20-Fr (6.0 [IQR: 4.0-8.0]) and non-ZERO 24-Fr (5.0 [IQR: 4.0-7.0]) groups. Pain during gastrostomy tube insertion was assessed as follows: the ZERO was replaced from a 24-Fr tube and a 20-Fr tube in 80 (44.4%) and 41 (22.8%) cases, respectively; a non-ZERO 20-Fr tube and a non-ZERO 24-Fr tube were inserted in 25 (13.9%) and 34 (18.9%) cases, respectively. The median BPS-NI score was significantly lower in the ZERO (replaced 24-Fr) group (3.0 [IQR: 3.0-3.3]) than in both the non-ZERO 20-Fr (5.0 [IQR: 3.0-6.0]) and non-ZERO 24-Fr (5.0 [IQR: 4.0-6.0]) groups.
Conclusions:
Use of the ZERO reduces pain during gastrostomy tube replacement.
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