The Endoscopic U-stitch Technique for Primary Button Placement: an Institution's Experience

Background: Various gastrostomy tube placement techniques have been reported in the literature. The endoscopic U-stitch technique allows for primary button placement without the need for laparoscopy. The purpose of this study was to quantify the completion rate and the occurrence of complications with this procedure at one academic teaching hospital.

Methods: All gastrostomy procedures between February 2001 and September 2008 were reviewed. Data were collected from paper and electronic records for endoscopic U-stitch procedures.

Results: Endoscopic U-stitch gastrostomies were attempted in 121 patients, with primary button placement in 115 (95%) and conversion to an open procedure in 6. No procedure-related deaths occurred, and 7% of patients experienced postoperative complications that included hematemesis, cellulitis, colonic perforation, granulation tissue requiring operative excision, and surgical fistula closure. Average operative time was 18 min.

Conclusion: The endoscopic U-stitch technique is safe and allows for primary button placement in infants and children. Its complication rate compares favorably with other laparoscopic and open techniques described in the literature.