Placement of a feeding button ("one-step button") as the initial procedure.

The procedure of choice for enteral feeding access is now percutaneous endoscopic gastrostomy (PEG). Standard PEG tubes have the disadvantages of clogging, stomal enlargement, and external bulkiness. Button replacement tubes can covert the more cumbersome PEG tubes to low external profile devices. A procedure and an early experience is described for placement of a button as a single-step procedure. This procedure is an over-the-wire, "push" procedure. Sixty-nine buttons were placed, 47 (61%) for neurologic reasons and 22 (32%) for cancer and other reasons. In 49 of the 69 (71%), there was no difficulty at all with insertion, and in only two (3%) could the button not be placed. Complications were assessed at 48 h and at 3 wk. No complications were found in 61 (90%). In only two patients (3%) were there serious complications (gastro-colon-cutaneous fistula and "peritonitis"). The One-Step Button represents a rapid, safe procedure for the placement of a low-profile PEG with its attendant advantages.