Purpose or Case Report: To evaluate the safety, technical success and outcome of image-guided ‘one-step’ retrograde balloon gastrostomy tube insertions in children.

Methods & Materials: A retrospective single center review was conducted by querying our RIS/PACS system to retrieve all gastrostomy procedures between 2018 and 2019. Each case was individually reviewed to determine the technique, what type of device was inserted, any procedural complications, and other potentially relevant demographic data.
The procedures were performed under general anesthesia or moderate to deep sedation, using a Halyard Mic-Key balloon gastrostomy kit with an additional securement device. Ultrasound and fluoroscopic guidance were used in all procedures. Gastrostomy tube insertion technique, technical success, safety, and outcome were analyzed. All patients were followed up until full feeds were reached. Patients were then seen in the gastrostomy clinic 2 weeks and 8 weeks after the procedure.

Results: There was a total of 46 procedures, comprising 39 one step button insertions (34 gastrostomies and 5 gastrojejunostomies) and 7 retrograde pigtail gastrostomy insertions. The pigtail gastrostomies were inserted as a fall back plan when the one step button gastrostomy insertions were deemed too risky.
Technical success was achieved in 44/46 (96%) procedures (2 were aborted. 40/46 (87%) of gastrostomy insertions, were uneventful. Of the remaining 6, there were 2 dislodgments and 4 superficial site infections which occurred within the first six months of starting the interventional service and were attributed to post-procedure care challenges.

Conclusions: Image-guided ‘one-step’ retrograde balloon gastrostomy tube insertion is a valuable and safe technique for establishing gastric feeding in children.