Original articleEndoscopic gastrostomy placement in the child with gastroesophageal reflux: is concomitant antireflux surgery indicated?
Section snippets
Materials and methods
Medical records of patients undergoing gastrostomy placement between April 1997 and January 2004 were reviewed to identify patients in whom gastrostomy was performed in the presence of pathologic GER. Pathologic GER was defined by esophageal pH study as an esophageal pH of 4 or less during at least 4% of the time measured. Patients with esophageal discontinuity (esophageal atresia, caustic injury, and esophageal stricture) were excluded from the study group, as were patients who had undergone a
Results
In the study period, 121 patients underwent placement of gastrostomy catheter. Preoperative 24-hour pH-metry was successfully performed for 79 patients, demonstrating pathologic GER in a group of 28 patients. We report here data and outcomes for these 28 patients.
There were 16 male and 12 female patients. Median age was 3 years and 2 months (range, 5 months to 18 years). Follow-up was a median of 22 months (range, 3 months to 6 years).
Medical history included neurologic impairment in 21
Discussion
The indications for gastrostomy placement in children fall broadly into 3 categories: inability to swallow efficiently, of which a large proportion is in neurologically impaired children; need for extraordinarily high or continuous energy intake, such as for patients suffering chronic disease or short bowel syndrome; and children dependant on an unpalatable diet or medication [8]. Although there are clear benefits to gastrostomy tube placement as compared with long-term nasogastric tube feeding
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