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Feeding gastrostomy in neurologically impaired children: is an antireflux procedure necessary?
J C Langer1, D E Wesson, S H Ein
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Routine antireflux procedures (ARP) are not recommended for neurologically impaired children undergoing feeding gastrostomy (FG). The study found that the incidence of developing gastroesophageal reflux (GER) after FG alone does not justify a routine protective ARP.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurology
Background:
- Feeding gastrostomy (FG) is common in neurologically impaired children.
- Antireflux procedures (ARP) are sometimes recommended routinely with FG to prevent gastroesophageal reflux (GER).
Purpose of the Study:
- To evaluate the necessity of routine protective antireflux procedures (ARP) in neurologically impaired children undergoing feeding gastrostomy (FG).
Main Methods:
- Retrospective analysis of 107 neurologically impaired children who underwent FG.
- Preoperative radiological assessment for GER in 98 children.
- Comparison of outcomes between FG alone and FG with simultaneous or subsequent ARP.
Main Results:
- 44% of patients without initial GER developed symptomatic GER after FG alone.
- No significant difference in mortality or early morbidity between FG alone and FG with ARP.
- Risk of GER after FG alone was not influenced by patient demographics or FG method.
Conclusions:
- A routine "protective" ARP is not justified in neurologically impaired children undergoing FG.
- The incidence of symptomatic GER post-FG alone does not warrant routine prophylactic ARP.
Abstract:
Some authors recommend a routine "protective" antireflux procedure (ARP) in neurologically impaired children undergoing feeding gastrostomy (FG). Over 4 years, we performed FG in 107 neurologically impaired children aged 1 month to 16 years. Ninety-eight had preoperative radiological assessment for gastroesophageal reflux (GER), which was documented in 44, of whom 33 had FG plus ARP and 11 had FG alone. Seven of the 11 subsequently developed symptomatic GER and 5 of them had a secondary ARP. Of the 54 children with no demonstrable GER preoperatively, 3 children underwent FG plus ARP. The remaining 51 had FG alone. There was one postoperative death. Of the 50 surviving patients, 22 developed symptomatic GER and 17 of these had a subsequent ARP. Mean follow-up of 20.0 months showed that the risk of developing GER after FG alone was not influenced by age, sex, indication for FG, underlying diagnosis, or method of gastrostomy. There was no significant difference in mortality and early morbidity between patients undergoing FG alone and those having FG with simultaneous or subsequent ARP. Only 44% of our patients in whom GER was not demonstrated initially developed symptomatic GER followed FG alone. This incidence does not justify a routine "protective" ARP.