Original article
Endoscopic gastrostomy placement in the child with gastroesophageal reflux: is concomitant antireflux surgery indicated?

https://doi.org/10.1016/j.jpedsurg.2006.04.021Get rights and content

Abstract

Background/Purpose

Previously, we performed concomitant antireflux surgery in patients with abnormal pH study undergoing gastrostomy. This increased complications without always alleviating the troublesome symptom of vomiting. In contrast, vomiting with normal preoperative pH study generally disappeared after gastrostomy placement. Therefore, we changed policy to perform only gastrostomy, regardless of pH study results. Subsequent antireflux surgery is performed only as necessary. We report here our results.

Methods

We retrospectively reviewed patients undergoing gastrostomy from April 1997 to January 2004. For patients with abnormal preoperative pH studies, detailed data were recorded including medical history, indication for gastrostomy, operative technique, symptoms of gastroesophageal reflux (GER), and use of antireflux medication. Symptomatic GER postgastrostomy was managed pharmacotherapeutically. If this proved inadequate, patients underwent antireflux surgery.

Results

Twenty-eight patients with abnormal pregastrostomy pH study entered the study. Median age was 3 years and 2 months. Seventy-five percent were neurologically impaired. Indication for gastrostomy was inadequate oral nutrition in 26 of 28 patients. Only 3 of 28 patients were asymptomatic for GER. Of the 25 symptomatic patients 19 improved postgastrostomy (6 did not). Antireflux surgery ultimately proved indicated in 2 patients (7% [2/28]). The asymptomatic patients remained asymptomatic.

Conclusions

For patients with abnormal pH study presenting primarily for gastrostomy placement, concomitant antireflux surgery is not 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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