Skin‐Level Gastrostomy Using a Novel Balloon‐Type Device—Long‐Term Results in Oncological Patients

Abstract

Objective: The usefulness of skin level gastrostomy tubes (button systems) for maintaining nutrition support after primary insertion of percutaneous endoscopic gastrostomy (PEG) is widely accepted. Technical and usability problems have forced the development of new systems. The experience with a newly developed skin‐level gastrostomy system (Freka‐Button Gastrostomy) in oncological patients is described. Methods: In a cohort study we prospectively evaluated for ease of use, complications, and time to failure, a modified balloon button system based on the MIC‐Key type. It differs from other systems by its application mode and balloon design. Since February 1998, 18 systems were applied in 15 patients (median age 56 years, 42 to 72 years, 14 men, 1 woman). Results: Correct application of the 18 buttons in 15 individuals was easy and fast to perform (median intervention time 10.8 minutes). During follow‐up (median 201, range 2 to 590 days) 1 button was removed because of the patient's decision, 2 others had to be renewed because of technical problems, and no major complication occurred. Conclusions: The new Freka‐button system provides an easy‐to‐use, safe, and feasible alternative for long‐term use of skin‐level gastrostomy tubes in oncological patients.

Endoscopic Techniques for Enteral Nutrition: Standards and Innovations

“…The second type of complications occurs later in the course and consists mainly of rupture of the retention balloon or valve problems [54]. We did not experience many balloon ruptures in the long-term follow-up with the Freka button which was the main problem reported by authors using balloon systems, predominatly in children [52]. During a long-term follow-up period of over 46 months, we inserted 61 buttons in 50 patients.…”

“…The indications for these devices are mostly peristomal problems and the patient's wish for indepence from the PEG tube [52]. Contraindications are active peristomal infection, a stoma existing !4 weeks after primary PEG insertion, a fistulous stoma channel, and stoma tracts longer than 4.5 cm [52].…”

“…Contraindications are active peristomal infection, a stoma existing !4 weeks after primary PEG insertion, a fistulous stoma channel, and stoma tracts longer than 4.5 cm [52].…”

“…In cases with a narrow stoma, a bougienage can be performed prior to button insertion over the wire. After filling the retention balloon with saline under endoscopic control, the procedure is completed by removing the endoscope with the snared internal bumper of the PEG [52].…”

Einzeitige Button-Gastrostomie mittels Gastropexie – klinische Ergebnisse einer neuen Technik zur perkutanen Sondenanlage

“…Buttonsysteme mit Ballons als Rückhaltemechanismus werden seit 1991 kommerziell angeboten und haben wegen ihrer komfortablen Anwendung und des großen Spektrums an Längen und Durchmessern eine zunehmende klinische Verbreitung gefunden [1]. Mit den heute verfügbaren Systemen kann die enterale Ernährung in der Regel sicher gewährleistet werden [2].…”