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Endoscopic gastrostomy placement in the child with gastroesophageal reflux: is concomitant antireflux surgery
Guin J P Wilson1, David C van der Zee, Nikolaas M A Bax
1Department of Pediatric Surgery (KE.04.140.5), Wilhelmina Children's Hospital, University Medical Center, PO Box 85090, 3508 AB Utrecht, The Netherlands.
Insights
For children needing gastrostomy, performing antireflux surgery concurrently is not recommended, even with abnormal pH studies. Gastrostomy alone often resolves vomiting, with antireflux surgery reserved for persistent cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Gastroesophageal Reflux
Background:
- Concomitant antireflux surgery with gastrostomy in patients with abnormal pH studies previously led to increased complications without consistent symptom relief.
- Vomiting often resolved post-gastrostomy in patients with normal preoperative pH studies, prompting a policy change.
Purpose of the Study:
- To evaluate the outcomes of a revised policy: performing gastrostomy alone and reserving antireflux surgery for cases where it is strictly necessary.
- To determine the indication for antireflux surgery in patients with abnormal preoperative pH studies undergoing gastrostomy.
Main Methods:
- Retrospective review of 28 patients with abnormal preoperative pH studies undergoing gastrostomy between April 1997 and January 2004.
- Data collected included medical history, gastrostomy indication, operative technique, gastroesophageal reflux (GER) symptoms, and medication use.
- Symptomatic GER was managed pharmacologically, with surgery considered if medical treatment failed.
Main Results:
- The study included 28 patients, with a median age of 3 years and 2 months; 75% had neurological impairments.
- Inadequate oral nutrition was the primary indication for gastrostomy in 26 patients.
- Of 25 symptomatic patients, 19 improved post-gastrostomy; only 2 patients (7%) ultimately required antireflux surgery.
Conclusions:
- Concomitant antireflux surgery is not indicated for patients with abnormal pH studies who primarily require gastrostomy placement.
- Gastrostomy alone is effective in managing symptoms, with antireflux surgery reserved for refractory cases.
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.
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