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Esophageal biopsy does not predict clinical outcome after percutaneous endoscopic gastrostomy in children
1Division of Gastroenterology, Department of Pediatrics, Medical College of Wisconsin, and The Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
Insights
Percutaneous endoscopic gastrostomy (PEG) can lead to symptomatic gastroesophageal reflux. Esophageal histology at the time of PEG insertion does not reliably predict which patients will develop intractable reflux after the procedure.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
Background:
- Symptomatic gastroesophageal reflux is a known complication following percutaneous endoscopic gastrostomy (PEG).
- Current preoperative evaluations do not accurately predict patients who will develop severe reflux post-PEG.
Purpose of the Study:
- To determine if esophageal histology obtained during PEG insertion can predict the development of intractable gastroesophageal reflux.
- To correlate clinical outcomes with esophageal histology in pediatric patients undergoing PEG.
Main Methods:
- Retrospective review of 68 children undergoing PEG with esophageal biopsy.
- Comparison of preoperative reflux evaluations (upper GI series, pH probe, reflux scan), esophageal histology, and post-PEG clinical outcomes.
Main Results:
- 57% of esophageal biopsies showed normal histology.
- 10% of patients developed symptomatic gastroesophageal reflux requiring intervention post-PEG.
- Only one patient with post-PEG reflux had evidence of esophagitis on biopsy.
Conclusions:
- Preoperative esophageal histology is not a reliable predictor of symptomatic gastroesophageal reflux after PEG placement.
- Further research may be needed to identify reliable predictors of post-PEG reflux.
Abstract:
Clinically symptomatic gastroesophageal reflux may occur after percutaneous endoscopic gastrostomy (PEG). Preoperative evaluation for gastroesophageal reflux does not reliably predict those individuals who will develop reflux unresponsive to medical management after PEG. Esophageal histology at the time of PEG might be used to identify patients at risk for developing intractable gastroesophageal reflux. The study aim was to correlate the clinical outcome after PEG with esophageal histology at the time of PEG insertion. A retrospective review of 68 consecutive children who had an esophageal biopsy obtained at the time of PEG insertion was undertaken. Preoperative evaluation, esophageal histology, and clinical outcomes were compared. Preoperative gastroesophageal reflux was present in 23% of upper gastrointestinal series performed, in 10% of pH probe studies, and in 29% of reflux scans. Histology was normal in 57% of esophageal biopsies obtained at the time of PEG insertion. Symptomatic gastroesophageal reflux requiring antireflux surgery or conversion to gastrojejunostomy developed in 10% of patients after PEG placement. Only one of these patients had esophagitis on biopsy. In conclusion, preoperative esophageal histology does not reliably predict the development of symptomatic gastroesophageal reflux after PEG placement.