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Is endoscopic follow-up needed in pediatric patients who undergo surgery for GERD?
Nino Guarino1, Emanuela Ceriati, Antonio Zaccara
1Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Strada del nobile 23, 10131 Turin, Italy.
Insights
Postoperative endoscopy is crucial for managing GERD after fundoplication. A defective fundoplic wrap increases esophagitis risk, necessitating surveillance to detect recurrence early.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Gastroesophageal Reflux Disease (GERD) Management
Background:
- Evaluating the utility of endoscopy in the postoperative care of pediatric patients undergoing fundoplication for GERD.
- Assessing the long-term outcomes and potential complications following surgical intervention for GERD.
Purpose of the Study:
- To determine the role of endoscopic surveillance in the management of pediatric patients post-fundoplication.
- To investigate the relationship between fundoplic wrap integrity and the recurrence of esophagitis.
- To identify the optimal timing for endoscopic evaluation after fundoplication surgery.
Main Methods:
- Retrospective review of medical records for 109 pediatric patients who underwent fundoplication for GERD between 1979 and 1996.
- Exclusion of patients with respiratory symptoms or esophageal stenosis.
- Serial endoscopic evaluations at early (within 1 year) and late (1-2 years) postoperative periods, assessing wrap appearance and esophagitis.
Main Results:
- Esophagitis was observed in patients with both intact and defective wraps, with a higher incidence in those with defective wraps at late endoscopy (17/defective vs. 5/intact, p < 0.05).
- A defective fundoplic wrap was significantly associated with the recurrence of esophagitis.
- Early endoscopic findings did not show a significant difference in esophagitis rates between intact and defective wraps.
Conclusions:
- Fundoplication with an intact wrap does not guarantee prevention of GERD recurrence.
- Endoscopic surveillance is recommended 1-2 years post-fundoplication to detect asymptomatic esophagitis.
- Early detection and treatment of esophagitis, identified via endoscopy, can prevent symptom development and manage GERD recurrence effectively.
Background:
This study evaluated the role of endoscopy in the postoperative management of pediatric patients who undergo fundoplication for GERD.
Methods:
Medical records of 109 otherwise healthy children who underwent operation for GERD from 1979 to 1996 were reviewed. Patients with respiratory symptoms or esophageal stenosis were excluded. All patients underwent endoscopic surveillance with endoscopy being performed in the early (within 1 year) and late (between 1 and 2 years) postoperative periods. Specifically evaluated were the appearance of the wrap and evidence of esophagitis. The risk of a recurrence of esophagitis based on wrap appearance and the presence of clinical symptoms in patients with endoscopic evidence of esophagitis were also evaluated.
Results:
At early endoscopy 3 patients with an intact wrap and 8 with a defective wrap had esophagitis (not significant). At late endoscopy, 5 patients with an intact wrap and 17 with a defective wrap had esophagitis (p < 0.05).
Conclusions:
An intact wrap does not prevent recurrence of GERD. Such an occurrence is even more likely when endoscopy demonstrates a defective wrap. For all patients who have undergone fundoplication, endoscopic evaluation at 1 to 2 years is recommended to detect esophagitis in the absence of symptoms so treatment can be initiated before symptoms occur.