Simplified "push" technique for percutaneous endoscopic gastrostomy in children.

Percutaneous endoscopic gastrostomy (PEG) by the "pull" technique is the standard method in pediatric patients. Modifications have been reported for adults but few in children. Problems with the "pull" technique including pericatheter infection due to contamination of the tube tract with oral flora, repeated insertion of the endoscope, potential esophageal injury from the catheter, and the possible need for another endoscopy for catheter removal, prompted our interest in a simpler technique. The "push" technique requires insertion of the endoscope only once to insufflate and visualize the insertion site. A modified Seldinger technique is used to insert a 14F acrylic Foley catheter. We have used this technique to place PEG tubes in 8 children age 6 weeks to 17 years (mean, 6 years), for failure to thrive due to cystic fibrosis (3), neurological impairment (4), and undetermined cause (1). Operative time averaged 15 minutes. All PEGs were used within 24 hours. This "push" technique of PEG insertion is safe, simple, quick, and obviates many of the potential risks inherent in the "pull" technique. The "push" technique deserves a more widespread application in children.