USE OF THE GENIE™ LOW-PROFILE CONVERSION KIT AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT IN CHILDREN

Abstract

Percutaneous endoscopic gastrostomy (PEG) has become the preferred method of gastrostomy tube placement in children for nutritional support. Conversion of the PEG tube to a low profile level device is often deferred for 6-12 weeks after PEG placement to avoid disruption of the PEG tract. The Genie™ (Bard, Billerica, MA) provides a method of conversion to a low profile device without removal of the original PEG tube. The tube is clamped at skin level, cut, then a plug with an antireflux valve and retention clip are attached to the tube. This allows flexibility with regard to timing of conversion as it can be performed at the time of original PEG placement or delayed if so required. The purpose of this retrospective study was to assess the technique and complication rate of conversion to the Genie™ low profile device after PEG tube placement in children. Eight subjects, 4-18 years of age, weight 10-60 kg, had Genie™ low profile devices placed at Morristown Memorial Hospital between May 1996 and June 1997. Underlying diagnoses were spastic quadriplegia (4), cystic fibrosis (2), Rett syndrome (1), and Dandy-Walker malformation (1). Using general anesthesia and peri-operative antibiotics, #20 French Ponsky™ PEG tubes were placed by the “push” technique (over a guidewire). The tube was converted to the low profile device immediately in 3 subjects. In the other 5 patients, conversion was performed 2 days to 4 months later. Length of follow-up after conversion ranged from 1 week to 1 year. No significant complications were noted during conversion or in follow-up. One patient developed incompetence of the antireflux valve 3 months after conversion, treated by traction removal of the device and replacement with a different low profile device. There were no episodes of internal bolster migration into the tract or separation of components of the low profile device. Conclusion: The Genie™ low profile conversion kit can be used in children and has the advantage of early conversion to a low profile device. Use of the device avoids the discomfort and cost of a second procedure. There were no major complications noted from conversion to the low profile device. Longer follow up is necessary to determine the durability of the device over time.