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Is Routine Upper Gastrointestinal Contrast Study Necessary prior to Laparoscopic Gastrostomy Tube Placement in
Shannon N Acker1, Becky B Trinh1, David A Partrick2
1Department of Surgery, University of Colorado, Aurora, Colorado, United States.
Insights
Routine upper gastrointestinal contrast studies before pediatric gastrostomy tube placement are unnecessary. Malrotation is rare, and reflux findings poorly correlate with antireflux procedures, suggesting UGI is not cost-effective.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Preoperative upper gastrointestinal contrast studies (UGI) are often requested before pediatric gastrostomy tube (GT) placement.
- These studies aim to identify gastroesophageal reflux (GER) or intestinal malrotation.
- This study questions the necessity of routine UGI before GT placement.
Purpose of the Study:
- To evaluate the diagnostic yield and clinical utility of routine preoperative UGI studies before GT placement in children.
- To determine the incidence of malrotation and the correlation between UGI findings and antireflux procedures.
Main Methods:
- Retrospective review of 500 pediatric patients undergoing GT placement between 2009 and 2012.
- Analysis of UGI study results, including diagnoses of malrotation and GER.
- Assessment of concurrent antireflux procedures performed with GT placement.
Main Results:
- Only 0.25% of UGI studies identified malrotation requiring surgical correction.
- GER findings on UGI weakly correlated with the decision to perform an antireflux procedure.
- 33% of patients without radiographic GER still underwent concurrent fundoplication.
Conclusions:
- Routine preoperative UGI studies before pediatric GT placement have a low diagnostic yield for malrotation.
- The correlation between UGI findings of GER and the performance of antireflux surgery is weak.
- The practice of routine UGI before laparoscopic gastrostomy placement in children is likely unnecessary.
Introduction:
Before gastrostomy tube (GT) placement, many pediatric surgeons request that children undergo a preoperative upper gastrointestinal contrast study (UGI) to evaluate for the presence of either gastroesophageal reflux (GER) or intestinal malrotation. We hypothesized that routine UGI is unnecessary before GT placement.
Materials And Methods:
We performed a retrospective review of 500 consecutive children who had a GT placed in a single children's hospital from 2009 to 2012.
Results:
There were 403 children who underwent UGI before planned GT placement; 196 of which were placed during the same hospitalization. Only 1/403 (0.25%) diagnosis of malrotation was identified on UGI, and treated with a Ladd procedure at the time of GT placement. There were 154 children who had evidence of reflux on UGI; 97 underwent an antireflux procedure in conjunction with GT placement. An additional 57 children with no evidence of reflux on UGI also underwent a concurrent antireflux procedure. Of these 160 children who underwent concurrent fundoplication, only 3 (2%) had a confirmatory pH probe study performed before GT placement.
Conclusions:
We found that in children undergoing routine preoperative UGI before GT placement (1) the risk of malrotation is less than 1%; (2) the decision to perform an antireflux procedure weakly correlates with the UGI findings of GER; and (3) one in five patients without radiographic GER still underwent concomitant fundoplication with or without confirmatory pH probe study. We conclude that the practice of routine UGI before laparoscopic gastrostomy placement in children is likely unnecessary.
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