Comparison of two different low-profile gastrostomy enteral feeding devices in pediatric oncology patients

Purpose: To describe the occurrence and type of complications in two low-profile enteral feeding devices (LPFD) at St. Jude Children's Research Hospital (SJCRH). Methods: The medical records of 36 patients who received gastric feedings via the Bard® or MIC-KEY® devices between 1994 and 1997 were retrospectively reviewed. Results: Patients began tube feedings at a median age of 12.1 years (range, 1 month to 18.7 years). Twenty-four patients were at nutritional risk at time of gastrostomy tube (GT) placement. Although 29 patients received GTs originally, 11 eventually received a Bard® Button and 19 eventually received a MIC-KEY®. Six never received a low-profile device. Nutrition support continued for a median of 8.3 months (range, 17 days to 23 months). One or more complications occurred in 30 patients and were categorized as mechanical (leakage, 8; broken balloon, 5; deflated balloon, 1; dislodged tube, 11; clogged tube, 1; valve malfunction, 1; damaged cover, 1) or feeding related (nausea/vomiting, 12; nausea/constipation, 4; diarrhea, 3). Twenty patients (56%) achieved or maintained ideal body weights with nutrition support. Conclusions: Both feeding devices are effective in improving or maintaining the nutritional status of pediatric oncology patients undergoing cancer therapy. Mechanical complications were higher in the MIC-KEY® group due to the balloon. Awareness of the incidence and type of complications allowed us to select one LPFD for use at our institution and to develop uniform standards of care. Despite the higher complication rate, the MIC-KEY® is preferred because of the decreased level of pain associated with accessing the stoma and ease of care.