Comparative Analysis of Conventional Ideal Button Versus New Ideal Button ZERO for Percutaneous Endoscopic Gastrostomy Catheter Replacement.

Objectives: Regular exchange of percutaneous endoscopic gastrostomy (PEG) catheters is crucial for preventing infection and maintaining function; however, procedure-related complications and patient discomfort remain major concerns. This study aimed to compare the clinical outcomes of the conventional Ideal Button with those of the newly developed Ideal Button ZERO (Olympus Corporation). Methods: In this retrospective observational study, we included 82 PEG catheter exchange procedures, performed in 42 patients. Because some patients underwent repeated exchanges, analyses were conducted on a per-procedure basis. Patients were categorized into two groups: Group N (conventional to conventional Ideal Button exchange, n = 33) and Group Z (exchange to Ideal Button ZERO, n = 49). Group Z was further subdivided into subgroups Z1 (conventional to ZERO, n = 29) and Z2 (ZERO to ZERO, n = 20). The outcomes included the procedure time, complication rates (procedure-related and postoperative), and family satisfaction score. Results: Procedure-related complications occurred only in Group Z (0/33 vs. 6/49; 0% vs. 12.2%) (p = 0.076). Postoperative complication rates were similar between the groups (Group N 6/33 [18.2%] vs. Group Z 9/49 [18.4%], p = 1.00). However, procedure time was shorter in Group Z than in Group N (8.24 ± 5.21 vs. 6.14 ± 4.28 min, p = 0.049). Family satisfaction scores showed no significant differences between the groups (Group N: 3.88 ± 1.52 vs. Group Z: 3.94 ± 1.39, p = 0.854). Conclusions: The new Ideal Button ZERO showed a reduced procedure time; however, it revealed a trend toward higher procedure-related complications without clear superiority over conventional devices. Improved proficiency with the new device may reduce complication rates, warranting further investigation as its adoption increases. Trial Registration: 2025-047.