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Published on: September 22, 2023
Routine gastrostomy tube placement in children: Does preoperative screening upper gastrointestinal contrast study
Paulette I Abbas1, Bindi J Naik-Mathuria1, Adesola C Akinkuotu1
1Texas Children's Hospital and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, Texas, 77030.
Insights
Routine upper GI studies before gastrostomy tube placement rarely detect malrotation. This study suggests that upper GI imaging is unnecessary for these patients, potentially reducing radiation exposure.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Upper GI (UGI) studies are commonly used to screen for malrotation before gastrostomy (G) tube placement.
- The clinical utility of routine preoperative UGI studies for G-tube placement is not well-established.
Purpose of the Study:
- To evaluate the effectiveness of preoperative UGI studies in identifying malrotation prior to G-tube placement in pediatric patients.
- To determine if routine UGI screening is necessary before G-tube insertion.
Main Methods:
- A retrospective review was conducted on pediatric patients who underwent surgically placed G-tubes between 2011 and 2013.
- Patients who also had fundoplications were excluded from the analysis.
Main Results:
- Of 393 patients, 299 (76%) had preoperative UGI studies, identifying malrotation in only 11 (3.7%).
- Malrotation was confirmed preoperatively in 1.7% of patients, with 5 undergoing Ladd's procedure.
- Malrotation rates did not significantly differ between infants and older children or between neurologically impaired and normal children.
Conclusions:
- Preoperative UGI studies identified malrotation in a small percentage of patients undergoing routine G-tube placement.
- The findings suggest that routine UGI screening may be unnecessary before G-tube placement, potentially avoiding radiation exposure.
- Further prospective studies are recommended to confirm these findings.
Background:
Upper GI (UGI) studies are routinely ordered to screen for malrotation before routine placement of gastrostomy (G) tubes. However, the usefulness of this study is unknown.
Methods:
A retrospective review of children with surgically placed G-tubes over a 2 year period (2011-2013) was performed. Patients with concomitant fundoplications were excluded.
Results:
Three hundred ninety-three patients underwent G-tube placement. Of these, 299 patients (76%) had preoperative UGI, and 11 patients (3.7%) were identified with malrotation on UGI. Five (1.7%) patients underwent a Ladd's procedure. The remaining 6 either had malrotation associated with gastroschisis (n=5) or were lost to follow-up (n=1). Children <1 year did not have different rates of malrotation compared to older children (4.3% vs. 3.2%, p=0.617). Likewise, children with neurologic impairment (NI) had similar rates of malrotation compared to neurologically normal (NN) children (2.6% vs. 3.8%, p=0.692). The only significant difference in malrotation rate was between those with congenital gastrointestinal anomalies (24%) and those without (1.5%) (p<0.001).
Conclusion:
Preoperative screening UGI before routine G-tube placement led to an unexpected diagnosis of malrotation in only 1.7%. Given the added radiation risk associated with an UGI, our data suggest that an UGI is unnecessary prior to routine G-tube placement. A larger prospective study is warranted to validate these results.
